产妇发生意外硬脊膜穿刺后的慢性疼痛：一项病例对照前瞻性观察研究
贵州医科大学 麻醉与心脏电生理课题组
翻译：马艳燕 编辑：张中伟 审校：曹莹
本研究调查产程中意外硬脊膜穿刺后硬脊膜穿刺后头痛（PDPH）妇女慢性头痛和背痛的发生率。
评估产后18-24个月慢性头痛、背痛和残疾的发生率。将接受硬膜外血补片(PDPH-EBP)治疗的PDPH患者与无硬膜外血补片的PDPH患者(PDPH-NO EBP)、单纯硬膜外镇痛患者和无硬膜外镇痛患者进行配对。本研究的主要结果是慢性头痛和背痛的发生率。次要结果是硬膜外补血对慢性疼痛发展的影响。本研究使用卡方检验或 Fisher's检验来计算优势比。
两组之间的人口统计特征没有统计学意义。在非硬膜外组中，没有女性发生慢性头痛，2/116例(1.7%)发生慢性背痛。在无并发症的硬膜外组中，无女性发生慢性头痛，7/116(6.0%例)报告慢性背痛。在PDPH-NO EBP组中，9/56(16.1%)妇女报告慢性头痛，10/56(17.9%)报告慢性背痛。PDPH-EBP组慢性头痛12/59例(20.3%)，慢性腰背痛14/59例(23.7%)。无硬膜外或无并发症硬膜外组无残疾报告(慢性疼痛评分为3或4)。PDPH-no EBP组和PDPH-EBP组分别有8.9%和8.4%的女性报告高度残疾。
患有PDPH的女性有较高的慢性头痛、背痛和残疾的发生率。本研究发现保守治疗和EBP治疗的患者在慢性疼痛发展方面的差异没有统计学意义。
Chronic pain in parturients with an accidental dural puncture: A case- controlled prospective observational study
Abstract
Background:We set out to examine incidence of chronic headache and back pain in women with PDPH after accidental dural puncture during labor.
Methods: Chronic headache, backache, and disability were assessed 18- 24 months postpartum. Women with PDPH treated with epidural blood patch (PDPH- EBP) were identified and matched with women who had a PDPH without epidural blood patch (PDPH- no EBP), with women with uncomplicated epidural analgesia and with women without epidural analgesia. Our primary outcome was incidence of chronic headache and backache. Secondary outcome was the effect of epidural blood patch on chronic pain development. We used Chi- square or Fisher's exact test to calculate odds ratios.
Results:There was no statistically significant difference in demographic characteristics between groups. In the no epidural group, no women reported chronic headache and 2/116 (1.7%) reported chronic backache. In the uncomplicated epidural group, no women reported chronic headache and 7/116 (6.0%) reported chronic backache. In the PDPH- no EBP group, 9/56 (16.1%) women reported chronic headache and 10/56 (17.9%) reported chronic backache. In the PDPH- EBP group, 12/59 (20.3%) had chronic headache and 14/59 (23.7%) had chronic backache. No women in the no epidural or uncomplicated epidural group reported disability (chronic pain score of 3 or 4). High disability was reported by 8.9% of women in the PDPH- no EBP group and by 8.4% in the PDPH- EBP group.
Conclusion:Women with PDPH had a high incidence of chronic headache, back pain, and disability. We did not find a statistically significant difference in chronic pain development between conservatively treated and EBP- treated patients.
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