综合序贯疗法治疗椎管内麻醉后头痛的临床研究

Study on Sequence Therapy for Post Dural Puncture Headache

目的:探讨椎管内麻醉后头痛的最佳序贯疗法。方法:选择椎管内麻醉后发生头痛的病例共45例,按设定的序贯疗法分别为A:去枕平卧1d,每天补液量增加1000ml平衡液,肌注曲马多100mg,无效时进入B和C;B:能进食者给予市售咖啡饮品,每天三次;C:不能进食者静脉注射氯胺酮0.5mg/kg,连用2d;以上治疗无效时进入D:行硬膜外填充自体血10ml。结果:基础治疗(A)有效者8例,为17.7%,且仅为单纯腰麻者,对硬外针穿破蛛网膜者无效;A无效进入B与C法同时治疗的有效例数为32例,有效率为73.3%,以上治疗方法无效者4例,采用D法全部治愈,无后遗症与并发症。结论:采用序贯疗法治疗椎管内麻醉后头痛,能遵循由简单无创向有创方法的渐进过渡,不耽误治疗时间,不增加患者痛苦,观察45例无后遗症与并发症。

Objective ：To explore a sequence therapy for post dural puncture headache（ PDPH）. Method：A three steps sequence therapy was designed for patients suffered post dural puncture headache total 45 cases ：step one ,patient keep supine recumbence, and intravenous injection of Ringer＇s solution 1000ml with intramuscular injection of Tramadol 100mg was administrated. If PDPH could not relieve within 24hr, the next step should be use. Step two, drinking a cup of coffee three times a day for patients who were allowed to eating or intravenous injection ketamine 0.5mg/kg for patient in fasting diet. Step three, an epidural blood patch was performed if headache did not alleviate by step one and two. Result：45 cases were observed. 8 cases（ 17.7% ） of PDPH were relieved by step one,all of these patients underwent lumbar anesthesia only. The effective rate of step two was 73.3%. All of the patients who did not respond to step one and two were cure by step three. Conclusion：The three steps sequence therapy was proved to be an effective treatment for post dural puncture headache.