自發性低腦壓頭痛病人的照護

頭痛是現代人身處緊張社會中常見的症狀，但若發作頻繁則對於生活的影響，若非親身經歷無法體會。目前醫學實證揭示引發頭痛的原因很多，顱內壓力的改變是重要因素。「自發性低腦壓頭痛」係指非因腰椎穿刺、手術或外傷所造成之脊椎硬膜裂孔伴隨腦脊髓液流失，導致腦壓降低而引發的姿勢性頭痛症候群，伴隨噁心嘔吐、頸部僵硬、坐姿或站立時產生劇烈頭痛等症狀。鑑別診斷依據腦部磁振造影顯現出硬腦膜兩側瀰漫性顯影，臨床醫師建議病人臥床休息、多攝取水份、咖啡因類食物及服用礦物質類固醇以增加體液容積等保守治療無法緩解時，近年最重要的治療方式是利用磁振影像定位脊椎滲漏處，直接在滲漏處注射病人血液使其凝固後封住裂孔，稱之為「硬腦膜外血液貼片」治療法。近年來全世界頭痛盛行率愈來愈高，此類病人長期反覆承受痼疾之擾，護理人員在臨床照護的第一線，從接觸初罹病者，教導病人認識疾病症狀、自我評估與紀錄過程、確診的各項檢查與治療活動，安撫病人情緒，提供心理與行動的支持，協助病人遵從治療後的居家保健指導等面向，都扮演著重要的角色，但國內對此疾病之照護議題則鮮見，希望藉由本文分享相關照護經驗提供護理同道參考。

關鍵字

頭痛；自發性低腦壓；硬腦膜外血液貼片

並列摘要

Spontaneous intracranial hypotension is defined as a postural headache syndrome without preceding head trauma or lumbar puncture, associated with low CSF volumes and pressures. Associated symptoms include stiff neck, nausea and vomiting. The most common MRI feature of SIH is diffuse pachymeningeal enhancement. Adjuvant treatment options include bed rest, continuous saline infusion, oral fludrocortisone, and intake of caffeine. At present, the management of patients with SIH can be directed by the findings on MRI-or CT-myelography with epidural blood patches targeted to CSF leakage sites. Nurses are on the firing line of clinical care for patients, including information taking, headache assessment, making arrangement for examination and treatment, and giving patients support. Providing the safest, most effective, and most appropriate care for patients can ease their headache and help the treatment successfully.

並列關鍵字

headache ； SIH ； epidural blood patch

國際替代計量

自發性低腦壓頭痛病人的照護

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