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題名:脊髓麻醉後臥床能否預防脊髓麻醉後頭痛
書刊名:醫學與健康期刊
作者:譚著文李妙紋林曉佩洪紹寧蕭文宜
作者(外文):Tan, Chu-wenLi, Miao-wenLin, Hsiao-peiHung, Shao-ningHsiao, Wen-yi
出版日期:2014
卷期:3:附冊1
頁次:頁31-39
主題關鍵詞:實證醫學脊髓麻醉硬脊膜穿刺後頭痛臥床活動Evidence-based medicineSpinal anesthesiaPDPHPost-dural puncture headacheBed restMobilization
原始連結:連回原系統網址new window
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臨床上,有些醫師會建議患者在接受脊髓麻醉後需臥床以防止頭痛發生,但臥床常導致患者不適感,甚至有些患者會發生下肢靜脈控塞。這篇是研究接受脊髓麻醉後臥床不動是否能預防頭痛發生?硬脊膜穿刺後頭痛為脊髓麻醉後最常見的合併症,其主要原因為腦脊液從硬脊膜流出,導致腦脊液容量下降,硬腦膜塌陷下來,拉扯而產生頭痛。患者典型症狀為前額都或枕部頭痛,坐起來時頭痛會加劇,但躺下後頭痛情形會改善。治療方面以臥床、補充水份、止痛藥及施行硬脊膜上血塊填補術。從這篇回顧發現,並沒有任何證據顯示,脊髓麻醉後臥床能預防頭痛發生,硬脊膜穿刺後頭痛並不會危及生命。所以,不建議在脊髓麻醉後以臥床來預防頭痛發生,可容許患者在病床上活動身體。
In clinical practice, Some doctors advise patients to remain in bed after a spinal anesthesia to prevent spinal headache, but bed rest often induced patients' discomfort or even complications such as venous stasis in people with risk factors. This review assess prolonged bed rest or immobilization can prevent post-dural puncture headache after spinal anesthesia? Postdural (post-lumbar or post-spinal) puncture headache is the most common complication of spinal anesthesia. It is caused by leakage of cerebrospinal fluid from the dural, resulting in a decrease in CSF volume and pressure may cause a downward pull on pain-sensitive structures resulting in a headache. Patients with PDPH characteristically present with frontal or occipital headache that is exacerbated in an upright position and improved in the supine position. In addition to symptomatic treatments such as bed rest, hydration, administration of analgesics and application of an epidural blood patch. This review found that there is no evidence to support bed rest or immobilization for preventing headache following lumbar puncture. Moreover, PDPH is not a life-threatening condition. Therefore, we suggested that bed rest after lumbar puncture (spinal anesthesia) to prevent post-dural puncture headache should not be routinely recommended. Patient should be allowed to move freely in bed.
期刊論文
1.Carbaat, P. A.、van Crevel, H.(1981)。Lumbar puncture headache: controlled study on the preventive effect of 24 hours' bed rest。Lancet,2,1133-1135。  new window
2.Amorim, J. A.、Gomes de Barros, M. V.、Valenca, M. M.(2012)。Postdural (post-lumbar) puncture headache: risk factors and clinical features。Cephalalgia,32(12),916-923。  new window
3.Kuntz, K. M.、Kokmen, E.、Stevens, J. C.(1992)。Post-lumbar puncture headaches: experience in 501 consecutive procedures。Neurology,42,1884-1887。  new window
4.Sechzer, P. H.、Abel, L.(1978)。Post-spinal anesthesia headache treated with caffeine. Evaluation with demand method。Current Therapeutic Research, Clinical and Experimental,24,307。  new window
5.Thoennissen, J.、Herkner, H.、Lang, W.(2001)。Dose bed rest after cervical or lumbar puncture prevent headache? A systematic review and meta-analysis。Canadian Medical Association Journal,165,1311-1316。  new window
圖書
1.刁茂盟、郭耀仁(2014)。實證醫學功夫談。新北市:合記圖書。  延伸查詢new window
單篇論文
1.Boonmak, P.,Boonmak, S.(2010)。Epidural blood patching for preventing and treating post-dural puncture headache(CD001791)。  new window
 
 
 
 
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