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脊麻后神经损伤及其法医学意义。

Nerve injuries after neuraxial anaesthesia and their medicolegal implications.

机构信息

Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.

出版信息

Best Pract Res Clin Obstet Gynaecol. 2010 Jun;24(3):367-81. doi: 10.1016/j.bpobgyn.2009.11.008. Epub 2010 Jan 6.

Abstract

Serious and permanent neurologic complications in the obstetric population are rare. Most neurologic complications following childbirth are intrinsic obstetric palsies. The most common intrinsic obstetric palsy is lateral femoral neuropathy. Palsies of the femoral, obturator, sciatic, common peroneal nerves and lumbosacral plexus have also been reported. Meticulous technique during neuraxial anaesthesia will decrease the risk of injury secondary to neuraxial procedures. Direct trauma to the spinal cord and spinal nerves may occur during neuraxial anaesthesia. Sterile technique should be employed during neuraxial procedures and precautions should be taken to ensure that the proper drug/concentration is being injected. Postpartum complaints should be addressed promptly. For infection and space-occupying lesions of the neuraxial canal, prompt diagnosis and treatment are essential to prevent permanent injury or death. Survey studies have demonstrated that women want to be told of the risks of neuraxial procedures, even when the incidence is rare.

摘要

产科人群中严重且永久性的神经系统并发症较为少见。大多数分娩后的神经系统并发症为固有产科性瘫痪。最常见的固有产科性瘫痪是股外侧皮神经病。也有报道称股神经、闭孔神经、坐骨神经、腓总神经和腰骶丛神经瘫痪。在进行椎管内麻醉时,精细的技术操作将降低因椎管内操作而导致的损伤风险。椎管内麻醉期间可能会发生脊髓和脊神经的直接损伤。椎管内操作时应采用无菌技术,并应采取预防措施,以确保正确的药物/浓度正在被注入。应及时处理产后并发症。对于椎管内的感染和占位性病变,及时诊断和治疗对于预防永久性损伤或死亡至关重要。调查研究表明,即使发病率较低,女性也希望被告知椎管内操作的风险。

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