Xu Risheng, Bydon Mohamad, Gokaslan Ziya L, Wolinsky Jean-Paul, Witham Timothy F, Bydon Ali
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Neurosurg Spine. 2009 Sep;11(3):358-64. doi: 10.3171/2009.3.SPINE0916.
Epidural steroid injections are relatively safe procedures, although the risk of hemorrhagic complications in patients undergoing long-term anticoagulation therapy is higher. The American Society for Regional Anesthesia and Pain Medicine has specific guidelines for treatment of these patients when they undergo neuraxial anesthetic procedures. In this paper, the authors present a case in which the current American Society for Regional Anesthesia and Pain Medicine guidelines were strictly followed with respect to withholding and reintroducing warfarin and enoxaparin after an epidural steroid injection, but the patient nevertheless developed a spinal epidural hematoma requiring emergency surgical evacuation. The authors compare the case with the 8 other published cases of postinjection epidural hematomas in patients with coagulopathy, and the specific risk factors that may have contributed to the hemorrhagic complication in this patient is analyzed.
硬膜外类固醇注射是相对安全的操作，尽管长期接受抗凝治疗的患者发生出血并发症的风险更高。美国区域麻醉和疼痛医学学会针对这些患者接受神经轴麻醉操作制定了具体指南。在本文中，作者介绍了一例病例，在硬膜外类固醇注射后严格遵循了美国区域麻醉和疼痛医学学会目前关于停用和重新使用华法林及依诺肝素的指南，但患者仍发生了需要紧急手术清除的脊髓硬膜外血肿。作者将该病例与其他8例已发表的凝血功能障碍患者注射后硬膜外血肿病例进行了比较，并分析了可能导致该患者出血并发症的具体危险因素。
