接受阿司匹林和低分子肝素治疗的患者硬膜外血肿的非典型表现。硬膜外镇痛是正确的选择吗？

Atypical presentation of an epidural hematoma in a patient receiving aspirin and low molecular weight heparin. Was epidural analgesia the right choice?

机构信息

Department of Anesthesia and Pain Management, Mount Sinai Hospital, Ontario, Canada.

出版信息

J Clin Anesth. 2009 Dec;21(8):595-8. doi: 10.1016/j.jclinane.2008.12.022.

DOI:10.1016/j.jclinane.2008.12.022

PMID:20122592

Abstract

A case of postoperative epidural hematoma with an atypical presentation and an excellent outcome in an 80 year-old woman who received both prophylactic aspirin and enoxaparin following a primary total knee arthroplasty, is presented. She developed lower limb neurological symptoms, fully recovered, and then deteriorated again. The hematoma was surgically evacuated, resulting in full neurological recovery. Epidural analgesia may not be the best choice for pain management in patients who require the combined use of aspirin and low-molecular weight heparin postoperatively.

摘要

本文报道了一位 80 岁女性患者的病例，她在初次全膝关节置换术后同时接受了预防性阿司匹林和依诺肝素治疗，术后出现了硬膜外血肿，表现不典型，结局极佳。她出现了下肢神经症状，完全恢复后再次恶化。血肿被手术清除，导致完全恢复了神经功能。对于需要联合使用阿司匹林和低分子量肝素的术后患者，硬膜外镇痛可能不是最佳的疼痛管理选择。