von Knobelsdorff G, Paris A
Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, St. Bernward Krankenhaus, Hildesheim.
Anaesthesist. 2004 Jan;53(1):41-4. doi: 10.1007/s00101-003-0585-9.
Intracerebral haemorrhage is a rare complication of spinal anaesthesia in obstetrics. A 37-year-old woman without any accompanying disease during a twin pregnancy, underwent an urgent caesarean section due to insufficiency of the placenta under spinal anaesthesia using hyperbaric bupivacain (0.5%) and a pencil-point spinal needle Sprotte 27 Gauge. The patient developed severe headache, a hemiparesis of the right upper limb and became somnolent and finally unconscious 80 min after the procedure. An immediately performed computed tomographic scan revealed a large acute intracerebral haemorrhage in the left hemisphere region with mass effect. The patient underwent temporoparietal craniotomy. No obvious cause of the haemorrhage, such as aneurysm or arteriovenous malformation was found. The patient fully recovered and was weaned from the respirator 32 h postoperatively. On postoperative day 7 the remaining neurologic deficits included aphasis and severe hemiparesis of the right upper limb and a right extensor plantar response. The neurologic status did not improve substantially until 6 months after the complication. The case and the recent literature are discussed.
颅内出血是产科脊髓麻醉的一种罕见并发症。一名37岁双胎妊娠女性，无任何伴随疾病，因胎盘功能不全在脊髓麻醉下使用重比重布比卡因（0.5%）和27G笔尖式Sprotte脊髓穿刺针行急诊剖宫产术。术后80分钟，患者出现严重头痛、右上肢偏瘫，继而嗜睡，最终昏迷。立即进行的计算机断层扫描显示左半球区域有一大块急性颅内出血并伴有占位效应。患者接受了颞顶开颅手术。未发现明显的出血原因，如动脉瘤或动静脉畸形。患者术后32小时完全康复并脱机。术后第7天，残留的神经功能缺损包括失语、右上肢严重偏瘫和右侧跖伸反应。直到并发症发生6个月后，神经功能状态才基本改善。本文讨论了该病例及近期文献。
