Dural Puncture Headache Weike Tao MD Spinal Needles

Dural Puncture Headache 硬脊膜穿刺后头痛 Weike Tao, MD

Spinal Needles

Cutting vs. non-cutting needle

Oops – I just wet-tapped her with a Tuohy. . . Wet tap - 1% 为最佳状态 PDPH > 50% 无脑脊液回流 – 仍有可能发生PDPH

机制 CSF渗漏 直立时颅内结构有一个向下的牵引力 CSF容量下降 通过血管舒张，使脑部血流量代偿性增加 Monro-Kellie doctrine Alexander Monro, Scottish anatomist and surgeon, 1733 -1817; George Kellie, Scottish anatomist, late 18 th century: An increase in volume of one component in the CNS will elevate pressure and decrease the volume of one of the other elements. Mosby's Medical Dictionary, 2009

30 min after injection. Beards, BJA 1997

9 hrs after injection. No compression, with clot “saddles”

3 hr after injection 18 hr after injection

血到处流动. . . 侧卧位注射 平均容积 = 14 m. L Six segments up, three segments down

有多少血合适? Szeinfeld, 1986 Tc-m 99 labeled RBC

7. 5 m. L 15 m. L

将导管置于合适的位置. . . Chestnut OBA Book 2009

预防 PDPH

Positive Culture ≠ �床感染 Tse, 2010 36