Massachusetts General Hospital, 15 Parkman Street, WACC 330, Boston, MA 02114, USA
Massachusetts General Hospital, 15 Parkman Street, WACC 330, Boston, MA 02114, USA.
Br J Anaesth. 2015 May;114(5):808-11. doi: 10.1093/bja/aeu461. Epub 2015 Jan 22.
Epidural haematoma is a rare but potentially catastrophic complication associated with epidural catheterization. The times of insertion and removal of epidural catheters are high-risk periods for epidural haematoma formation, especially with abnormal coagulation parameters. There is a lack of data on the incidence of epidural haematoma in patients with abnormal coagulation parameters.
A retrospective analysis was undertaken from 2002 to 2009 on patients with an epidural catheter. Queries were performed on the coagulation parameters for the dates of placement and removal of the catheters and on all documented epidural haematoma cases.
During the study period, 11 600 epidural catheters were placed. In the setting of abnormal coagulation parameters, 278 (2.4%) epidural catheters were placed and 351 (3%) were removed. Two epidural haematomas occurred; both patients had epidural catheters and spinal drains placed for vascular procedures with abnormal coagulation parameters after operatation. The haematomas occurred after removal of the catheters. Based on our study, the incidence of epidural haematoma in patients with abnormal coagulation parameters is 1 in 315 patients, with the lower limit of the 95% confidence interval at 87 and the upper limit at 2597.
The risk of epidural haematoma is clearly elevated with abnormal coagulation parameters. Our data suggest that as the incidence of epidural haematoma with neuraxial access in patients with abnormal coagulation is not 100%, individual risk-benefit evaluations are warranted.
硬膜外血肿是一种罕见但潜在灾难性的并发症，与硬膜外导管插入有关。硬膜外导管插入和拔出的时间是硬膜外血肿形成的高风险期，尤其是在凝血参数异常的情况下。目前，关于凝血参数异常患者中硬膜外血肿的发生率缺乏数据。
对 2002 年至 2009 年期间使用硬膜外导管的患者进行了回顾性分析。对导管放置和拔除日期的凝血参数以及所有记录的硬膜外血肿病例进行了查询。
在研究期间，共放置了 11600 根硬膜外导管。在凝血参数异常的情况下，放置了 278 根（2.4%）硬膜外导管，拔出了 351 根（3%）。发生了 2 例硬膜外血肿；这 2 例患者均因血管手术而在凝血参数异常的情况下放置了硬膜外导管和脊髓引流管，术后出现硬膜外血肿。血肿发生在导管拔除后。根据我们的研究，凝血参数异常患者硬膜外血肿的发生率为每 315 例患者中有 1 例，95%置信区间的下限为 87，上限为 2597。
凝血参数异常会显著增加硬膜外血肿的风险。我们的数据表明，由于凝血参数异常患者行神经轴突介入治疗后硬膜外血肿的发生率并非 100%，因此需要进行个体化的风险效益评估。
