• 四川大學(xué)華西第二醫(yī)院麻醉科（610041）;

目的 　探討產(chǎn)婦硬脊膜穿刺后頭痛（PDPH）的循證預(yù)防治療措施。
方法 　計(jì)算機(jī)檢索Cochrane圖書館（2006年第3期）、MEDLINE（1980.1～2006.10）和中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫（1980.1～2006.10），收集關(guān)于產(chǎn)婦硬脊膜穿刺后頭痛防治的系統(tǒng)評(píng)價(jià)、Meta分析和臨床對(duì)照試驗(yàn)（RCT），并評(píng)價(jià)所獲得的證據(jù)質(zhì)量。
結(jié)果 　共檢索到2篇Cochrane系統(tǒng)評(píng)價(jià)，2篇Meta分析和9篇RCT。分析結(jié)果表明，硬膜外自體血液填充治療療效確切，體位、液體和藥物治療對(duì)產(chǎn)婦PDPH的發(fā)生率和嚴(yán)重性無明顯影響。選擇適當(dāng)腰麻穿針刺和穿刺技術(shù)能有效降低產(chǎn)婦PDPH的發(fā)生，而蛛網(wǎng)膜下腔注入生理鹽水和置管預(yù)防技術(shù)的價(jià)值尚有待進(jìn)一步驗(yàn)證。
結(jié)論 　硬膜外自體血液填充對(duì)產(chǎn)婦的PDPH具有確切的治療作用, 選擇適當(dāng)腰麻穿刺針和穿刺技術(shù)能有效預(yù)防產(chǎn)婦PDPH的發(fā)生。

引用本文： 唐昱英,林雪梅,黃蔚. 產(chǎn)婦硬脊膜穿刺后頭痛的循證防治. 中國循證醫(yī)學(xué)雜志, 2007, 07(3): 226-229. doi: 復(fù)制

1. Choi PT, Galinski SE, Takeuchi L, et al. PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies. Can J Anaesth, 2003, 50(5): 460–469.
2. Naulty JS, Hertwig L, Hunt CO, et al. Influence of local anesthetic solution on postural puncture headache. Anesthesiology, 1990, 72(3): 450–454.
3. Candido KD, Stevens RA. Post-dural puncture headache: pathophysiology, prevention and treatment. Best Practice & Research Clinical Anaesthesiology, 2003, 17(3): 451–469.
4. Sudlow C, Warlow C. Posture and fluids for preventing post-dural puncture headache. Cochrane Database Syst Rev, 2002, 2:CD001790.
5. Sudlow C, Warlow C. Epidural blood patching for preventing and treating post-dural puncture headache. The Cochrane Database of Systematic Reviews 2006 Issue 3.
6. Richman JM, Joe EM, Cohen SR. Bevel direction and postdural puncture headache: a meta-analysis. Neurologist, 2006, 12(4): 224–228.
7. Tejavanija S, Sithinamsuwan P, Sithinamsuwan N, et al. Comparison of prevalence of post-dural puncture headache between six hour- supine recumbence and early ambulation after lumbar puncture in thai patients: A randomized controlled study. J Med Assoc Thai, 2006, 89(6): 814–820.
8. Abboud TK, Zhu J, Reyes A, et al. Effect of subarachnoid morphine on the incidence of spinal headache. Reg Anesth, 1992, 17(1): 34–36.
9. Camann WR, Murray RS, Mushlin PS, et al. Effects of oral caffeine on post-dural puncture headache: a double-blind, placebo-controlled trial. Anaesthesia and analgesia, 1990, 70(2): 181–184.
10. Sandesc D, Lupei MI, Sirbu C, et al. Conventional treatment or epidural blood patch for the treatment of different etiologies of post dural puncture headache. Acta Anaesthesiol Belg, 2005, 56(3): 265–269.
11. Landau R, Ciliberto CF, Goodman SR, et al. Complications with 25-gauge and 27-gauge Whitacre needles during combined spinal-epidural analgesia in labor. International Journal of Obstetric Anesthesia, 2001, 10(3): 168–171.
12. Douglas MJ, Ward ME, Campbell DC, et al. Factors involved in the incidence of post-dural puncture headache with the 25 gauge Whitacre needle for obstetric anesthesia. International Journal of Obstetric Anesthesia, 1997, 6(4): 220–223.
13. Paech M, Banks S, Gurrin L. An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients.International Journal of Obstetric Anesthesia, 2001, 10(3): 162–167.
14. Charsley MM, Abram SE. The injection of intrathecal normal saline reduces the severity of postdural puncture headache. Reg Anesth Pain Med, 2001, 26(4): 301–305.
15. Sabry Ayad, Yousef Demian, Samer N, et al. Subarachnoid catheter placement after wet tap for analgesia in labor: influence on the risk of headache in obstetric patients. Regional Anesthesia and Pain Medicine, 2003, 28(6): 512–515.
16. erger CW, Crosby ET, Grodecki W. North American survey of the management of dural puncture occurring during labour epidural analgesia. Can J Anaesth, 1998, 45(2): 110–114.
17. Connelly NR, Parker RK, Rahimi A, et al. Sumatriptan in patients with postdural puncture headache. Headache, 2000, 40: 316–319.
18. Paech M, Banks S, Gurrin L. An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients. International Journal of Obstetric Anesthesia, 2001, 10(3): 162–167.
19. Wu YW, Hui YL, Tan PP. Experience of epidural blood patch for post-dural puncture headache. Acta Anaesthesiol Sin, 1994, 32(2): 137–140.
20. Williams EJ, Beaulieu P, Fawcett WJ. Efficacy of epidural blood patch in the obstetric population. Int J Obstet Anesth, 1999, 8(2): 105–109.
21. Pamela J. Angle, Kamal Hussain, Anwar Morgan, et al. High quality labour analgesia using small gauge epidural needles and catheters. Can J Anesth, 2006, 53(3): 263–267.
22. Kuczkowski KM, Benumof JL. Decrease in the incidence of post-dural puncture headache: maintaining CSF volume. Acta Anaesthesiol Scand, 2003, 47(1): 98–100.
23. Cohen S, Pollak P. Caudal saline infusion treatment for post dural puncture headache. Int J Obstet Anesth, 2001, 10(2): 149–150.
  1. 1. Choi PT, Galinski SE, Takeuchi L, et al. PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies. Can J Anaesth, 2003, 50(5): 460–469.
  2. 2. Naulty JS, Hertwig L, Hunt CO, et al. Influence of local anesthetic solution on postural puncture headache. Anesthesiology, 1990, 72(3): 450–454.
  3. 3. Candido KD, Stevens RA. Post-dural puncture headache: pathophysiology, prevention and treatment. Best Practice & Research Clinical Anaesthesiology, 2003, 17(3): 451–469.
  4. 4. Sudlow C, Warlow C. Posture and fluids for preventing post-dural puncture headache. Cochrane Database Syst Rev, 2002, 2:CD001790.
  5. 5. Sudlow C, Warlow C. Epidural blood patching for preventing and treating post-dural puncture headache. The Cochrane Database of Systematic Reviews 2006 Issue 3.
  6. 6. Richman JM, Joe EM, Cohen SR. Bevel direction and postdural puncture headache: a meta-analysis. Neurologist, 2006, 12(4): 224–228.
  7. 7. Tejavanija S, Sithinamsuwan P, Sithinamsuwan N, et al. Comparison of prevalence of post-dural puncture headache between six hour- supine recumbence and early ambulation after lumbar puncture in thai patients: A randomized controlled study. J Med Assoc Thai, 2006, 89(6): 814–820.
  8. 8. Abboud TK, Zhu J, Reyes A, et al. Effect of subarachnoid morphine on the incidence of spinal headache. Reg Anesth, 1992, 17(1): 34–36.
  9. 9. Camann WR, Murray RS, Mushlin PS, et al. Effects of oral caffeine on post-dural puncture headache: a double-blind, placebo-controlled trial. Anaesthesia and analgesia, 1990, 70(2): 181–184.
  10. 10. Sandesc D, Lupei MI, Sirbu C, et al. Conventional treatment or epidural blood patch for the treatment of different etiologies of post dural puncture headache. Acta Anaesthesiol Belg, 2005, 56(3): 265–269.
  11. 11. Landau R, Ciliberto CF, Goodman SR, et al. Complications with 25-gauge and 27-gauge Whitacre needles during combined spinal-epidural analgesia in labor. International Journal of Obstetric Anesthesia, 2001, 10(3): 168–171.
  12. 12. Douglas MJ, Ward ME, Campbell DC, et al. Factors involved in the incidence of post-dural puncture headache with the 25 gauge Whitacre needle for obstetric anesthesia. International Journal of Obstetric Anesthesia, 1997, 6(4): 220–223.
  13. 13. Paech M, Banks S, Gurrin L. An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients.International Journal of Obstetric Anesthesia, 2001, 10(3): 162–167.
  14. 14. Charsley MM, Abram SE. The injection of intrathecal normal saline reduces the severity of postdural puncture headache. Reg Anesth Pain Med, 2001, 26(4): 301–305.
  15. 15. Sabry Ayad, Yousef Demian, Samer N, et al. Subarachnoid catheter placement after wet tap for analgesia in labor: influence on the risk of headache in obstetric patients. Regional Anesthesia and Pain Medicine, 2003, 28(6): 512–515.
  16. 16. erger CW, Crosby ET, Grodecki W. North American survey of the management of dural puncture occurring during labour epidural analgesia. Can J Anaesth, 1998, 45(2): 110–114.
  17. 17. Connelly NR, Parker RK, Rahimi A, et al. Sumatriptan in patients with postdural puncture headache. Headache, 2000, 40: 316–319.
  18. 18. Paech M, Banks S, Gurrin L. An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients. International Journal of Obstetric Anesthesia, 2001, 10(3): 162–167.
  19. 19. Wu YW, Hui YL, Tan PP. Experience of epidural blood patch for post-dural puncture headache. Acta Anaesthesiol Sin, 1994, 32(2): 137–140.
  20. 20. Williams EJ, Beaulieu P, Fawcett WJ. Efficacy of epidural blood patch in the obstetric population. Int J Obstet Anesth, 1999, 8(2): 105–109.
  21. 21. Pamela J. Angle, Kamal Hussain, Anwar Morgan, et al. High quality labour analgesia using small gauge epidural needles and catheters. Can J Anesth, 2006, 53(3): 263–267.
  22. 22. Kuczkowski KM, Benumof JL. Decrease in the incidence of post-dural puncture headache: maintaining CSF volume. Acta Anaesthesiol Scand, 2003, 47(1): 98–100.
  23. 23. Cohen S, Pollak P. Caudal saline infusion treatment for post dural puncture headache. Int J Obstet Anesth, 2001, 10(2): 149–150.