【罂粟摘要】地塞米松预防剖宫产患者腰麻后硬脊膜穿刺后头痛的双盲安慰剂对照试验
地塞米松预防剖宫产患者腰麻后硬脊膜穿刺后头痛的双盲安慰剂对照试验
探讨地塞米松在减少剖宫产（CS）患者腰麻后硬脊膜穿刺后头痛(PDPH)中的作用。
本研究对腰麻下行剖宫产的产妇进行了双盲安慰剂对照随机试验。在夹住脐带后将受试者(n=192)随机分配静脉注射2ml(8 mg)地塞米松(n=96)或生理盐水(n=96)。术后第1天和第4天采用视觉模拟评分(VAS)评估受试者PDPH的发生率和严重程度。主要观察指标是PDPH的发生率，次要观察指标为恶心和呕吐的发生率。采用意向性分析 (Intention-To- Treat, ITT)原则分析资料。
两组受试者的基线社会人口学和临床变量相似，所有受试者均参加随访。与生理盐水组相比，地塞米松组PDPH发生率(8.3% vs 25.0%; p =0.002)和恶心发生率(11.5% vs 25.0%; p =0.015)明显降低。生理盐水组的头痛严重程度在术后第一天( p<0 .001)和第四天(p<0 .001)较地塞米松组高。
预防性使用地塞米松可降低腰麻下行CS患者术后第1天和第4天PDPH的发生率和严重程度。与生理盐水组相比，地塞米松组的恶心发生率也有所改善。
原始文献来源：Okpala BC, Eleje GU, Ikechebelu JI, et al. A double-blind placebo controlled trial on effectiveness of prophylactic dexamethasone for preventing post- dural puncture headache after spinal anesthesia for cesarean section.[J] .J Matern Fetal Neonatal Med, 2020, undefined: 1-6.
A double-blind placebo controlled trial on effectiveness of prophylactic dexamethasone for preventing post- dural puncture headache after spinal anesthesia for cesarean section
Aim: To determine the effect of dexamethasone in reducing post-dural puncture headache(PDPH) after spinal anesthesia for cesarean section (CS).
Methods: A double blind placebo controlled randomized trial of parturients undergoing CS under spinal anesthesia was conducted. Participants (n = 192) were randomly (1:1 ratio) given either 2mls (8 mg) of dexamethasone (n= 96) intravenously or 2mls of normal saline (n = 96) intravenously as placebo after clamping the umbilical cord. Visual analogue scale was used to assess the incidence and severity of PDPH on the first and fourth post-operative days. The primary outcome measure was incidence of PDPH while the secondary outcome measure was incidence of nausea and vomiting. Analysis was by intention-to-treat.
Results: Baseline socio-demographic and clinical variables were similar between the two groups and none of the women was lost to follow up. The incidence of PDPH (8.3% vs 25.0%; p =0.002) and nausea (11.5% vs 25.0%; p =0.015) were significantly lower in dexamethasone group. The severity of headache in the control groups were statistically higher on the first (p < 0.001) and fourth (p < 0.001) post-operative days.
Conclusion: Prophylactic dexamethasone reduces the incidence and severity of PDPH on both the first and fourth post-operative day after spinal anesthesia for CS. There was also an improvement on the incidence of nausea on the dexamethasone group compared to control.
翻译：何幼芹 编辑：佟睿 审校：曹莹
贵州医科大学 高鸿教授课题组