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硬膜外血贴和纤维蛋白贴片治疗硬膜穿刺后头痛的差异性疗效
贵州医科大学 麻醉与心脏电生理课题组
翻译：严旭 编辑：王波 审校：曹莹
EFP在治疗产科PDPH方面，相较于EBP，表现出更高的疗效、更好的安全性及更高的患者满意度。
原始文献来源：López-Millán JM, Fernández AO, Fernández JM, et,al. Differential efficacy with epidural blood and fibrin patches for the treatment of post-dural puncture headache[J]. Pain Pract. 2024 Mar;24(3):440-448. doi: 10.1111/papr.13318.
Differential efficacy with epidural blood and fibrin patches for the treatment of post-dural puncture headache
Abstract
Background: Accidental dural puncture (ADP) is the most frequent major complication when performing an epidural procedure in obstetrics. Consequently, loss of pressure in the cerebrospinal fluid (CSF) leads to the development of post-dural puncture headache (PDPH), which occurs in 16%-86% of cases. To date, the efficacy of epidural fibrin patches (EFP) has not been evaluated in a controlled clinical trial, nor in comparative studies with epidural blood patches (EBP).
Methods: The objective of the present study was to compare the efficacy of EFP with respect to EBP for the treatment of refractory accidental PDPH. This prospective, randomized, open-label, parallel, comparative study included 70 puerperal women who received an EBP or EFP (35 in each group) after failure of the conventional analgesic treatment for accidental PDPH in a hospital.
Results: A higher percentage of women with EFP than EBP achieved complete PDPH relief after 2 (97.1% vs. 54.3%) and 12 h (100.0% vs. 65.7%) of the patch injection. The percentage of patients who needed rescue analgesia was significantly lower with EFP after 2 (2.9% vs. 48.6%) and 12 h (0.0% vs. 37.1%). After 24 h, PDPH was resolved in all women who received EFP. The recurrence of PDPH was reported in one woman from the EBP group (2.9%), who subsequently required a second patch. The mean length of hospital stay was significantly lower with EFP (3.9 days) than EBP (5.9 days). Regarding satisfaction, the mean value (Likert scale) was significantly higher with EFP (4.7 vs. 3.0).
Conclusions: EFP provided better outcomes than EBP for the treatment of obstetric PDPH in terms of efficacy, safety, and patient satisfaction.
