连续蛛网膜下腔注药分娩镇痛术后头痛的预防和治疗体会

[摘要] 目的 探讨Spinocath导管连续蛛网膜下腔阻滞分娩镇痛术后头痛的预防和治疗方法。 方法 将Spinocath导管连续蛛网膜下腔阻滞分娩镇痛产妇58例随机分为两组。A组（内径27G、外径22G Spinocath导管）29例，分娩结束后拔除导管；B组（内径29G、外径24G Spinocath导管）29例，分娩结束后从Spinocath导管向蛛网膜下腔注入无保存液的0.9%氯化钠溶液3～4 mL再拔管。观察两组孕妇分娩镇痛后头痛的发生率。产后头痛的产妇除常规处理外，应用天麻素注射液治疗。 结果 A组出现产后头痛17例（58.6%）；B组出现产后头痛1例（3.4%）。A、B两组头痛发生率比较差异有统计学意义（P ＜ 0.05）。头痛的产妇经治疗1～3 d均痊愈，随访无并发症。 结论 采用外径较小的Spinocath导管实施分娩镇痛及蛛网膜下腔充填无保存液的0.9%氯化钠溶液再拔管能预防头痛的发生；在常规处理的基础上应用天麻素注射液治疗分娩镇痛术后头痛效果显著。

[关键词] Spinocath导管；蛛网膜下腔；分娩镇痛；头痛

[中图分类号] R614.42 [文献标识码] A [文章编号] 1673-7210（2012）08（a）-0059-02

The headache prevention and treatment for continuous spinal anesthesia labor analgesia

QUAN Weibin LAO Chengyi ZHOU Chaoming XING Jijuan PENG Li HUANG Ruiping

Maternal and Child Healthy Hospital of Nanning City, Guangxi Zhuang Autonomous Region, Nanning 530011, China

[Abstract] Objective To discuss the headache prevention and treatment for Spinocath catheter continuous spinal anesthesia labor analgesia. Methods 58 pregnant patients with Spinocath catheter continuous spinal anesthesia labor analgesia were randomly divided into 2 groups: group A 29 cases (nside diameter 27G, outside diameter 22G Spinocath catheter), they pull the catheter after the childbirth; group B 29 cases (nside diameter 29G, outside diameter 24G Spinocath catheter), After childbirth, we injected without preservation solution of 0.9% sodium chloride solution 3 to 4 mL to their subarachnoid, and then pull out the pipe. The incidence of headache was observed. The headache was treated using Gastrodin Injection for the pregnant women in addition to conventional treatment. Results group A appeared in 17 cases of headache (58.6%)；group B appeared in 1 cases of headache(3.4%). A, B two groups in the incidence of headache had a significant difference (P ＜ 0.05). The maternal's headache were cured after 1-3 days treatment, without complication. Conclusion Using a smaller diameter Spinocath tube for labor analgesia and the subarachnoid space filling without preservation solution of 0.9% sodium chloride solution can prevent the occurrence of headache, We received good results of using gastrodin injection for analgesia of postoperative headache on the basis of conventional treatment.

[Key words] Spinocath catheter; Subarachnoid space; Labor analgesia; Headache、

椎管内神经阻滞分娩镇痛是目前最常用、效果最可靠的分娩镇痛方法，近年来也有持续蛛网膜下腔阻滞用于分娩镇痛的报道，但术后头痛发生率高是影响其在临床广泛应用的因素之一。我院自2010年10月起开展Spinocath导管连续蛛网膜下腔注药分娩镇痛的临床研究并对施行Spinocath导管连续蛛网膜下腔注药分娩镇痛的产妇进行综合预防和治疗产后头痛，取得良好效果，现报道如下：