自发性低颅压综合征自体硬膜外血贴片临床疗效研究
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摘要
目的:探讨自体硬膜外血贴片治疗自发性低颅压综合征(EBP)的效果与安全性。方法:回顾性分析2014年9月至2018年9月广州市第一人民医院收治的35例自发性低颅压综合征患者的临床资料,其中16例患者接受EBP治疗(观察组),19例患者接受保守治疗(对照组)。对比两组头痛首次缓解天数、视觉模拟评分(VAS)、复发率、有效率、不良事件发生率等指标。结果:观察组头痛缓解天数中位数为2.5(2,3) d,较对照组症状缓解天数5(4,6) d明显缩短(P=0.028)。治疗后2、3、5 d,观察组VAS评分较对照组更低(P<0.05)。两组各有1例患者出院1年内复发,观察组和对照组复发率分别为6.3%和5.3%,两组比较,差异无统计学意义(P>0.05)。两组不良事件发生率比较,差异无统计学意义(P>0.05)。结论:与保守治疗相比较而言,自体硬膜外血贴片能更快缓解EBP患者症状,有效性更高,且不增加不良事件发生率,值得临床推广。
Objective: To investigate the efficacy and safety of autologous epidural blood patch( EBP) in the patients with spontaneous intracranial hypotension( SIH) syndrome. Methods: The clinical data of 35 patients with SIH syndrome admitted to Guangzhou First Municipal People's Hospital between September 2014 and September 2018 were retrospectively analyzed. Sixteen patients received EBP treatment( study group) and 19 patients received conservative treatment( control group). The time to initial headache relief,visual analog scale( VAS) scores,recurrence rate,effective rate,and incidence of adverse events were compared between the two groups. Results: The median of time to headache relief in the study group was significantly shorter than that in the control group[2.5( 2,3) d vs. 5( 4,6) d,( P = 0.028) ]. At 2,3,and 5 d after the treatment,the VAS scores in the study group were significantly lower than those in the control group( P < 0. 05). There was 1 case of recurrence in each group within 1 year after discharged home. The recurrence rate in the study group and control group was 6. 3% and 5. 3%,respectively,and there was no statistically significant difference between the two groups( P>0.05). There was no statistically significant difference in the incidence of adverse events between the two groups( P > 0. 05). Conclusion: Compared with conservative treatment,autologous EBP relieves the symptoms in EBP patients more quickly,and it is more effective with lower incidence of adverse events,which justifies widespread use in the clinical settings.
Objective: To investigate the efficacy and safety of autologous epidural blood patch( EBP) in the patients with spontaneous intracranial hypotension( SIH) syndrome. Methods: The clinical data of 35 patients with SIH syndrome admitted to Guangzhou First Municipal People's Hospital between September 2014 and September 2018 were retrospectively analyzed. Sixteen patients received EBP treatment( study group) and 19 patients received conservative treatment( control group). The time to initial headache relief,visual analog scale( VAS) scores,recurrence rate,effective rate,and incidence of adverse events were compared between the two groups. Results: The median of time to headache relief in the study group was significantly shorter than that in the control group[2.5( 2,3) d vs. 5( 4,6) d,( P = 0.028) ]. At 2,3,and 5 d after the treatment,the VAS scores in the study group were significantly lower than those in the control group( P < 0. 05). There was 1 case of recurrence in each group within 1 year after discharged home. The recurrence rate in the study group and control group was 6. 3% and 5. 3%,respectively,and there was no statistically significant difference between the two groups( P>0.05). There was no statistically significant difference in the incidence of adverse events between the two groups( P > 0. 05). Conclusion: Compared with conservative treatment,autologous EBP relieves the symptoms in EBP patients more quickly,and it is more effective with lower incidence of adverse events,which justifies widespread use in the clinical settings.
引文
[1] Nagatani K,Takeuchi S,Wada K,et al. Treatment of spontaneous intracranial hypotension with intravenous Factor XIII administration:initial clinical experience[J].Turk Neurosurg,2015,25(1):69-72.
[2] Schievink W I,Dodick D W,Mokri B,et al. Diagnostic criteria for headache due to spontaneous intracranial hypotension:a perspective[J]. Headache,2011,51(9):1442-1444.
[3]Lin JP,Zhang SD,He FF,et al. The status of diagnosis and treatment to intracranial hypotension,including SIH[J]. J Headache Pain,2017,18(1):4.
[4]Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension[J]. JAMA,2006,295(19):2286-2296.
[5] Kong DS,Park K,Nam DH,et al. Atypical spontaneous intracranial hypotension(SIH)with nonorthostatic headache[J]. Headache,2007,47(2):199-203.
[6] Mokri B. Spontaneous Intracranial Hypotension[J].Continuum(MinneapMinn),2015,21(4 Headache):1086-1108.
[7]Beck J,Ulrich CT,Fung C,et al. Diskogenicmicrospurs as a major cause of intractable spontaneous intracranial hypotension[J]. Neurology,2016,87(12):1220-1226.
[8] Schievink WI,Moser FG,Maya MM,et al. Digital subtraction myelography for the identification of spontaneous spinal CSF-venous fistulas[J]. J Neurosurg Spine,2016,24(6):960-964.
[9] Rettenmaier LA,Park BJ,Holland MT,et al. Value of targeted epidural blood patch and management of subdural hematoma in spontaneous intracranial hypotension:case report and review of the literature[J]. World Neurosurg,2017,97:27-38.
[10]Cho KI,Moon HS,Jeon HJ,et al. Spontaneous intracranial hypotension:efficacy of radiologic targeting vs blind blood patch[J].Neurology,2011,76(13):1139-1144.
[2] Schievink W I,Dodick D W,Mokri B,et al. Diagnostic criteria for headache due to spontaneous intracranial hypotension:a perspective[J]. Headache,2011,51(9):1442-1444.
[3]Lin JP,Zhang SD,He FF,et al. The status of diagnosis and treatment to intracranial hypotension,including SIH[J]. J Headache Pain,2017,18(1):4.
[4]Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension[J]. JAMA,2006,295(19):2286-2296.
[5] Kong DS,Park K,Nam DH,et al. Atypical spontaneous intracranial hypotension(SIH)with nonorthostatic headache[J]. Headache,2007,47(2):199-203.
[6] Mokri B. Spontaneous Intracranial Hypotension[J].Continuum(MinneapMinn),2015,21(4 Headache):1086-1108.
[7]Beck J,Ulrich CT,Fung C,et al. Diskogenicmicrospurs as a major cause of intractable spontaneous intracranial hypotension[J]. Neurology,2016,87(12):1220-1226.
[8] Schievink WI,Moser FG,Maya MM,et al. Digital subtraction myelography for the identification of spontaneous spinal CSF-venous fistulas[J]. J Neurosurg Spine,2016,24(6):960-964.
[9] Rettenmaier LA,Park BJ,Holland MT,et al. Value of targeted epidural blood patch and management of subdural hematoma in spontaneous intracranial hypotension:case report and review of the literature[J]. World Neurosurg,2017,97:27-38.
[10]Cho KI,Moon HS,Jeon HJ,et al. Spontaneous intracranial hypotension:efficacy of radiologic targeting vs blind blood patch[J].Neurology,2011,76(13):1139-1144.