Moen Vibeke, Irestedt Lars
Department of Anaesthesiology and Intensive Care, Kalmar County Hospital, Kalmar, Sweden.
Curr Opin Anaesthesiol. 2008 Jun;21(3):275-80. doi: 10.1097/ACO.0b013e3282f8e22f.
The last few decades have seen an increased use of central neuraxial blockades in obstetric patients. Central blockades provide excellent labour analgesia and safe anaesthesia for caesarean section associated with low incidence of severe complications. Therefore, an increasing number of blockades are also performed in women affected by significant disease. The risks and benefits of central blockades, however, might differ in these patients. This review addresses the risks of neurological complications following central neuraxial blockades in healthy parturients as well as in women affected by significant haemostatic and neurological disease.
The low risk of complications following central neuraxial blockades applies primarily to women in developed countries. Infectious complications and in particular meningitis still occur, and more frequently so in developing countries. Judicious application of central blockades in women affected by neurological and haemostatic disorders may enhance patient satisfaction without increasing the risk for complications.
Estimation of the incidence of neurological complications following central neuraxial blockades to women affected by significant disease on the basis of case reports and small series of patients is impossible. Prospective registration of high-risk patients may increase our knowledge. Application of central neuraxial blockade must follow individual evaluation.
在过去几十年中，产科患者越来越多地使用中枢神经轴索阻滞。中枢阻滞可为剖宫产提供出色的分娩镇痛和安全的麻醉，且严重并发症发生率低。因此，越来越多的患有重大疾病的女性也接受了此类阻滞。然而，中枢阻滞在这些患者中的风险和益处可能有所不同。本综述探讨了健康产妇以及患有重大止血和神经疾病的女性在接受中枢神经轴索阻滞后发生神经并发症的风险。
中枢神经轴索阻滞后并发症风险低主要适用于发达国家的女性。感染性并发症，尤其是脑膜炎仍有发生，在发展中国家更为常见。对患有神经和止血障碍的女性谨慎应用中枢阻滞可能会提高患者满意度，而不会增加并发症风险。
根据病例报告和小样本患者系列来估计患有重大疾病的女性接受中枢神经轴索阻滞后神经并发症的发生率是不可能的。对高危患者进行前瞻性登记可能会增加我们的认识。中枢神经轴索阻滞的应用必须经过个体化评估。
