一例妊娠期间硬膜外脂肪增多症：分娩及剖宫产术中的处理
A Case of Epidural Lipomatosis in Pregnancy: Management during Labour and Caesarean Section.
作者信息
Smith Martha K, Martin Rachel, Robblee Jennifer, Shore Eliane M
机构信息
Faculty of Medicine, University of Toronto, Toronto, ON.
Department of Anaesthesia, St. Michael's Hospital, Toronto, ON; Department of Anaesthesia, University of Toronto, Toronto, ON.
出版信息
J Obstet Gynaecol Can. 2018 Sep;40(9):1182-1185. doi: 10.1016/j.jogc.2018.04.011. Epub 2018 Jul 11.
BACKGROUND
Spinal epidural lipomatosis (SEL) is a rare condition of adipose tissue accumulation in the epidural space. As a result of excess adipose tissue, neuraxial anaesthesia has been reported to behave unpredictably in patients with this condition.
CASE
A 36-year-old woman had worsening postural headaches during pregnancy. MRI revealed SEL involving the thecal sac between L3/L4 and L5/S1. She had induction of labour but ultimately required a CS for delivery. Her anaesthesia was managed with an epidural inserted at L3/4. She developed a high block with relative sacral sparing.
CONCLUSION
Although neuraxial anaesthesia was thought to be contraindicated in patients with SEL, it can be done safely. Care must be taken to provide slow epidural titration to avoid high sensory block in patients with this condition.
背景
脊髓硬膜外脂肪增多症（SEL）是一种硬膜外间隙脂肪组织积聚的罕见病症。据报道，由于脂肪组织过多，患有这种病症的患者在接受神经轴麻醉时表现难以预测。
病例
一名36岁女性在怀孕期间姿势性头痛加重。磁共振成像（MRI）显示SEL累及L3/L4和L5/S1之间的硬膜囊。她接受了引产，但最终分娩需要剖宫产。她的麻醉通过在L3/4置入硬膜外导管进行管理。她出现了高位阻滞，骶部相对保留。
结论
尽管SEL患者被认为禁忌接受神经轴麻醉，但仍可安全实施。必须谨慎进行硬膜外缓慢滴定，以避免此类患者出现高位感觉阻滞。
Zotero 插件