使用 26G Quincke-Babcock 切割斜面脊髓穿刺针进行急诊和择期下段剖宫产术(LSCS)比较硬膜外腰椎穿刺后头痛(PDLPH)的发生率

IF 1.3 Q3 ANESTHESIOLOGY Saudi Journal of Anaesthesia Pub Date : 2024-06-04 DOI:10.4103/sja.sja_950_23
Monika Kambale, Sammita J Jadhav
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引用次数: 0

摘要

剖腹产通常在脊髓麻醉下进行,也称为蛛网膜下腔阻滞(SAB),而不是全身麻醉。由于使用的剂量较小,局麻药中毒的风险较低,药物转移到胎儿身上的风险也很小。产科病人出现硬膜穿刺后头痛(PDPH)的风险较高。硬脊膜穿刺后头痛是由于脑脊液(CSF)通过脊髓穿刺针造成的孔洞渗漏所致。影响 PDPH 发生频率的因素有很多,包括年龄、女性性别、针头大小和类型、妊娠、PDPH 先前记录、穿刺过程中中位数与医护人员的区别、穿刺水平等。PDPH 通常表现为额部、枕部或眶后头痛,在硬膜穿刺后 12-72 小时开始,站立时头痛加剧,躺下或休息时头痛减轻。我们的目的是了解在足月孕妇中使用 26 G Quincke 脊柱穿刺针进行择期和急诊下段剖宫产术的头痛频率。 研究使用 26G Quincke 脊柱针的 PDPH 发生率。分析PDPH发生率的诱因/决定因素,如充分预处理液体、脊髓针的大小、刺入次数和腰椎穿刺技术的影响。 本研究是一项基于问卷的前瞻性比较观察研究,采用方便抽样法。研究人员在浦那拉瓦尔的共生大学医院和研究中心接受了结构化问卷调查。研究观察的患者年龄在 20 至 40 岁之间,急诊或择期下段剖宫产,体重指数(BMI)小于 14.5 至 24.9,ASA I 级和 II 级。有任何合并症、复发性头痛、肥胖和脊柱畸形的患者均被排除在外。根据文献综述并借助公式,计算出样本量为 20 人;10 名患者为择期 LSCS 患者,10 名患者为急诊 LSCS 患者。 在 20 名患者中,10 名患者被派往进行择期 LSCS,其余 10 名患者则在脊髓麻醉下进行急诊 LSCS。在 10 名急诊 LSCS 患者中,只有 2 名患者出现了 PDPH,而择期 LSCS 患者中没有出现 PDPH。
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Incidence of post-dural lumbar puncture headache (PDLPH) in comparison between emergency and elective lower segment cesarean section (LSCS) with 26G Quincke–Babcock cutting-beveled spinal needle
C-section is usually performed under spinal anesthesia also known as a subarachnoid block (SAB) over general anesthesia. Because of the lesser amount of dose used, there is a lower risk of local anesthetic toxicity and minimal transfer of drugs to the fetus. Obstetric patients have a higher risk of having post-dural puncture headache (PDPH). PDPH occurs due to leakage of the cerebrospinal fluid (CSF) through the hole created by a spinal needle. There are many elements affecting the frequency of PDPH, these elements can also consist of age, female sex, needle size, and types, pregnancy, preceding records of PDPH, median–paramedian distinction in approach, a puncture level. PDPH is commonly in the form of a frontal, occipital, or retro-orbital headache that starts in 12–72 h after the dural puncture and will increase when standing and decrease when lying down or resting. We aimed to learn about headache frequency between elective and emergency lower segment cesarean section using 26-G Quincke spinal needle in full-term pregnant patients. To study the incidence of PDPH using the 26G Quincke spinal needle. To analyze the causal factors/determinants such as adequate preloading of fluids, size of spinal needle, number of pricks, and technique of lumbar puncture effects on the incidence of PDPH. This study is a prospective questionnaire-based comparative observational study using the convenience sampling method. The patients were interviewed with a structured questionnaire at the Symbiosis University Hospital and Research Centre, Lavale, Pune. The patients observed for the study were between 20 and 40 of age group, posted for emergency or elective lower segment cesarean section, with body mass index (BMI) less than 14.5 to 24.9 and with ASA I and II grades. Patients with any comorbidities, recurrent headaches, obesity, and spine deformity were excluded. According to the review of the literature and with the help of a formula, the sample size was calculated as 20; 10 patients for elective LSCS, and 10 patients for emergency LSCS. Out of 20 patients, 10 patients were posted for elective LSCS, and the rest 10 patients were for emergency LSCS under spinal anesthesia. The incidence of PDPH was found only in 2 out of 10 emergency LSCS patients, and no patients from elective LSCS cases showed up with the incidence of PDPH.
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来源期刊
CiteScore
1.90
自引率
8.30%
发文量
141
审稿时长
36 weeks
期刊最新文献
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