Deglaire B, Duverger P, Muckensturm B, Maissin F, Desbordes J M
Département d'Anesthésie-Réanimation, Hôpital Jean Bernard, Poitiers.
Ann Fr Anesth Reanim. 1988;7(2):156-8. doi: 10.1016/s0750-7658(88)80145-x.
A case is reported of an acute intracranial subdural haematoma following an accidental dural puncture during an epidural anaesthesia. A seventy-year old man, class ASA I, was operated on for prostatic adenoma under epidural anaesthesia. Dural puncture occurred during the first introduction of the needle into the L4-L5 epidural space. Epidural anaesthesia was nevertheless obtained by introducing the catheter at the L3-L4 level. The immediate peroperative and postoperative course was uneventful, apart from persisting headache. After removing the epidural catheter at 24 h postoperatively, the patient received calcium heparinate. 26 h later, he complained of worsening headache and became rapidly deeply comatose. The computer tomographic scan showed air in the ventricles and a large right-sided subdural haematoma which was immediately discharged. Although the link between subdural haematoma and dural puncture is well known, the acuteness and rapidly fatal evolution of this case were exceptional and may have been facilitated by the big size of the needle, dehydration and hypercoagulability.
报告了1例硬膜外麻醉期间意外硬膜穿刺后发生急性颅内硬膜下血肿的病例。一名70岁男性，ASA I级，在硬膜外麻醉下接受前列腺腺瘤手术。首次将穿刺针插入L4-L5硬膜外间隙时发生硬膜穿刺。不过，通过在L3-L4水平置入导管仍获得了硬膜外麻醉。围手术期及术后即刻过程顺利，仅持续存在头痛。术后24小时拔除硬膜外导管后，患者接受了肝素钙治疗。26小时后，他主诉头痛加重并迅速陷入深度昏迷。计算机断层扫描显示脑室内有气体及右侧巨大硬膜下血肿，该血肿立即被引流。尽管硬膜下血肿与硬膜穿刺之间的关联已为人熟知，但该病例的急性起病及迅速致命的进展情况实属罕见，可能与穿刺针尺寸较大、脱水及高凝状态有关。
