Sharpe E E, Arendt K W, Jacob A K, Pasternak J J
Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Int J Obstet Anesth. 2015 Feb;24(1):77-84. doi: 10.1016/j.ijoa.2014.11.001. Epub 2014 Nov 11.
With improvements in management and rehabilitation, more women with spinal cord injury are conceiving children. Physiologic manifestations of spinal cord injury can complicate anesthetic management during labor and delivery. Patients who delivered at Mayo Clinic, Rochester, Minnesota between January 1, 2001 and May 31, 2012 with a history of traumatic spinal cord injury were identified via electronic record search of all parturients. Eight patients undergoing nine deliveries were identified. Six deliveries (67%) among five patients (63%) involved a trial of labor. Among these deliveries, three (50%) occurred vaginally, all with successful epidural analgesia. Trial of labor failed in the remaining three patients, and required cesarean delivery facilitated via epidural (n=1), spinal (n=1) and general anesthesia (n=1). Three patients (33%) underwent scheduled cesarean delivery via epidural (n=1), spinal (n=1), and general anesthesia (n=1). Four patients having five deliveries had a history of autonomic hyperreflexia before pregnancy. One patient had symptoms during pregnancy, two patients had episodes during labor and delivery, and three patients described symptoms in the immediate postpartum period. These symptoms were not reported by any patient without a history of autonomic hyperreflexia. Neuraxial labor analgesia may have a higher failure rate in patients with spinal cord injury, possibly related to the presence of Harrington rods. Postpartum exacerbations of autonomic hyperreflexia are common in patients with a history of the disorder.
随着管理和康复水平的提高，越来越多的脊髓损伤女性正在怀孕生子。脊髓损伤的生理表现会使分娩期间的麻醉管理变得复杂。通过对所有产妇的电子记录搜索，确定了2001年1月1日至2012年5月31日期间在明尼苏达州罗切斯特市梅奥诊所分娩且有创伤性脊髓损伤病史的患者。共确定了8例患者进行了9次分娩。5例患者（63%）中的6次分娩（67%）尝试了阴道分娩。在这些分娩中，3例（50%）经阴道分娩，均成功实施了硬膜外镇痛。其余3例患者阴道分娩失败，需要通过硬膜外麻醉（n = 1）、脊髓麻醉（n = 1）和全身麻醉（n = 1）进行剖宫产。3例患者（33%）通过硬膜外麻醉（n = 1）、脊髓麻醉（n = 1）和全身麻醉（n = 1）进行了择期剖宫产。4例患者进行了5次分娩，在怀孕前有自主神经反射亢进病史。1例患者在孕期出现症状，2例患者在分娩期间出现发作，3例患者在产后立即出现症状。没有自主神经反射亢进病史的患者均未报告这些症状。脊髓损伤患者使用椎管内分娩镇痛的失败率可能更高，这可能与哈灵顿棒的存在有关。有自主神经反射亢进病史的患者产后病情加重很常见。
