摘要
虽然近年来硬膜外及腰麻的技术在不断改进,但临床上仍时有硬膜穿透后头痛(PDPH)发生,由此还可能引发医疗纠纷。麻醉医生为产妇提供舒适化硬膜外分娩镇痛的同时,应掌握对PDPH这一最常见并发症的预防、诊断和治疗。本文总结了PDPH的发病机制,发生PDPH的一系列相关因素、持续时间、除头痛外其他并发症、PDPH引起的法律诉讼、鉴别诊断和几种治疗方案,强调了血补丁(EBP)治疗的有效性,并解答常见的临床问题。
Although techniques of epidural and spinal anesthesia have improved gradually in recent years,post-dural puncture headache( PDPH) still happens,as a result,sometimes it may cause medical malpractice dispute. While providing epidural analgesia for obstetric patients,anesthesiologists should master the skills how to prevent,diagnose and treat PDPH,the most common complication of epidural and spinal anesthesia. This article thoroughly reviews the pathophysiology,a series of attributing factors,duration,other clinical manifestation,malpractice claims,differential diagnosis and several treatment options of PDPH,emphasizes the effectiveness of epidural blood patch and answers common questions in our daily practice.
作者
曹锡清
于春华
王芸
CAO Cathy;YU Chunhua;WANG Yun(Department of Anesthesiology,Medstar Washington Hospital Center,Washington DC 20010,USA;Department of Anesthesiology,Peking Union Medical College Hospital,Beijing 100730,China;Department of Anesthesiology,Mid-Atlantic Permanente MedicalGroup,Maryland 20879,USA)
出处
《麻醉安全与质控》
2019年第1期41-50,共10页
Perioperative Safety and Quality Assurance
关键词
意外穿透硬膜
硬膜穿透后头痛
顺势置管
头痛鉴别诊断
血补丁
accidental dural puncture(ADP)
post-dural puncture headache(PDPH)
insertion spinal catheter after ADP
differential diagnosis of headache
epidural blood patch
