경막천자 후 두통 환자에서 투시장치 유도하 경막외 혈액 봉합술의 효과고찰 = The Efficacy of a Fluoroscopy Guided Epidural Autologous Blood Patch In the Treatment of a Post-Dural Puncture Headache

국문 초록 (Abstract)

목적: 경막천자 후 두통 환자에서 투시장치(fluoroscopy) 유도하 경막외 혈액 봉합술의 치료 효과를 평가하였다.
대상과 방법: 2013년 11월부터 2017년 4월까지 경막천자 후 발생한 두통 치료를 위해 본원 영상의학과에서 경막외 혈액봉합술을 시행 받은 164명의 의무기록을 후향적으로 분석하였다. 치료 효과는 완전 경감(complete relief), 불완전 경감(incomplete relief), 치료 실패(failure), 재발(recurrence)로 분류하였다. 재발한 경우 경막외 혈액 봉합술 시술일로부터 재발한 날 사이의 기간과 재시술 유무를 기술하고, 재시술 후 치료 효과를 기술하였다.
결과: 경막천자 후 체위성 두통을 호소하는 총 164명의 환자 중 첫 번째 경막외 혈액 봉합술 이후 157명(95.8%)에서 완전 경감을 보였다. 1명(0.6%)의 환자에서 불완전 경감, 2명(1.2%)의 환자에서는 치료 실패를 보였고 4명의 환자에서 재발했다. 4명의 재발 환자 및 2명의 치료 실패 환자 모두 추가적인 경막외 혈액 봉합술을 시행(1회)받은 후 모두 완전 경감 상태로 퇴원하였다.
결론: 경막천자 후 두통 환자에서 투시장치 유도하에 경막외 혈액 봉합술을 시행하여 체위성 두통의 치료를 효과적으로할 수 있으며, 임상적으로 경막외 혈액 봉합술 시행 후에 발생한 두통의 치료 실패/재발의 경우 반복적인 경막외 혈액 봉합술을 고려해볼 수 있다.

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate the efficacy of a fluoroscopy-guided epidural blood patch (EBP) in the treatment of a post-dural puncture headache (PDPH).
Materials and Methods: From November 2013 to April 2017, a total of 164 patients (76 males, 88 females, mean age 40.7 years, age range 12 to 87 years) underwent a fluoroscopy guided EBP for the treatment of PDPH in the department of radiology.
The treatment outcomes were classified as follows: complete relief, incomplete relief, failure, and recurrence. In the case of recurrence, the duration between the date of the first EBP and the date of recurrence was described. The effectiveness of the second EBP was also evaluated.
Results: In 164 PDPH patients, complete relief was achieved in 157 patients (95.8%), incomplete relief was achieved in 1 patient (0.6%), failure in 2 patients (1.2%) and recurrence in 4 patients after the first EBP. All 4 recurrence patients and the 2 failure patients were discharged with complete relief after receiving one additional EBP.
Conclusion: In patients with PDPH, a fluoroscopy-guided EBP is an effective treatment.
Moreover, an additional EBP can be considered in the clinical failure or recurrence of PDPH after the first EBP.

참고문헌 (Reference)

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