非靶向硬膜外自体静脉血补片疗法治疗自发性低颅压头痛的临床观察

Clinical observation on the treatment of spontaneous intracranial hypotension with blind epidural autologous blood patch

目的 通常的硬膜外自体静脉血补片疗法操作过程复杂,危险性很高,且不能完全开展,本研究采用非靶向硬膜外自体静脉血补片疗法治疗低颅压头痛,对该方法的治疗机制及应用价值等方面进行讨论报告,并对非靶向硬膜外血贴的治疗机制和应用价值等进行讨论。方法 6例自发性颅内低压患者（男性2例,女性4例,年龄44~70岁）,符合2004年国际头痛分类第2版诊断标准,采用非靶向硬膜外自体静脉血补片疗法治疗,选择在腰椎1~2水平椎间隙进行穿刺,行硬膜外置管,将新鲜自体静脉血迅速通过硬膜外置管缓慢注入硬膜外间隙,并对所有患者进行随诊。结果 6例患者经非靶向硬膜外自体静脉血补片治疗后均痊愈。其中有4例患者治疗1次后痊愈,1例患者治疗2次后痊愈,1例患者在原注射治疗处的下一椎间隙处行硬膜外自体静脉血补片治疗,头痛症状仍未得到完全缓解,后又在相同位置进行2次硬膜外自体静脉血补片疗法治疗,术后观察3~9个月均无复发。结论 非靶向硬膜外自体静脉血补片疗法是一种安全、有效的自发性颅内低压治疗手段,该方法不仅操作简单,而且危险性小且无需影像学漏点定位,亦有不错的治疗效果,因此可得到较好的开展。

Objective To discuss therapeutic mechanism and application value of blind epidural autologous blood patch in the treatment of spontaneous intracranial hypotension（SIH）. Methods All patients met the diagnostic criteria of 2nd e- dition of international classification of headache disorders （2004）. The blind epidural autologous venous blood patch was performed in 6 patients with SIH （2 males and 4 females, aged 44 -70 years）. The puncture and external epidural cathe- ter was performed at intervertebral disc space between L1 and L2. The Fresh autologous venous blood was transferred into epidural space through the catheter. All the patients were followed up to observe the therapeutic efficacy. Results All pa- tients responded well to the treatment and achieved a complete resolution of symptoms. Among the 6 patients ,4 cases re- covered by the first procedure, l case recovered after the second transfusion, the other one received additional epidural au- tologous venous blood patch treatment between L2 and L3 one time, and L1 and L2 two times. The 3 - 9 months follow up showed that there was no recurrence after the operation. Conclusion The blind epidural blood patch is an effective, safe and easy way to treat spontaneous intracranial hypotension, not need the leakage point location by imaging. Key words：Spontaneous intracranial hypotension;Epidural autologous blood patch;Cerebrospinal fluid leak