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硬膜外镇痛治疗晚期妊娠合并边缘性前置胎盘的腔静脉后输尿管绞痛发作1例报告

Epidural analgesia for the treatment of colic attack with retrocaval ureter in late pregnancy complicated with marginal placenta previa: a case report.

作者信息

Iwasaki Soshi, Hamada Kohsuke, Takahashi Kazunobu, Takahashi Mika, Mizuno Eri, Mizukami Naomi, Yamakage Michiaki

机构信息

Department of Anesthesiology, Sapporo Medical University, South1, West16, Chuo-ku, Sapporo City, Hokkaido, Japan.

Ain Holdings and Nitori Holdings Department of Palliative Medicine, Sapporo Medical University, South1, West16, Chuo-ku, Sapporo City, Hokkaido, Japan.

出版信息

JA Clin Rep. 2019 Aug 14;5(1):52. doi: 10.1186/s40981-019-0271-9.

Abstract

BACKGROUND

Retrocaval ureter was diagnosed in a woman complaining of ureteric pain in the last trimester of pregnancy. We describe the rationale behind the administration of epidural analgesia for her colic attack.

CASE PRESENTATION

A 41-year-old pregnant woman was hospitalized with a diagnosis of a marginal placenta previa at 34 weeks and 5 days of pregnancy. Her right ureter encircled the dorsal aspect of the inferior vena cava (IVC) and was compressed by a growing fetus, causing hydronephrosis. Her right lower back pain was exacerbated every day, till an epidural catheter was inserted. Her estimated glomerular filtration rate (eGFR) and hematocrit worsened, and an elective cesarean section was performed.

CONCLUSION

Epidural analgesia only provided pain relief for a few days. When a pregnant woman presents with a retrocaval ureter and severe pain, short-term epidural analgesia should be considered after evaluating the complex medical condition and size of the fetus.

摘要

背景

一名在妊娠晚期主诉输尿管疼痛的女性被诊断为腔静脉后输尿管。我们描述了对其绞痛发作给予硬膜外镇痛的理由。

病例介绍

一名41岁孕妇,在妊娠34周零5天时因边缘性前置胎盘入院。她的右输尿管环绕下腔静脉(IVC)的背侧,并被不断生长的胎儿压迫,导致肾积水。她的右下背部疼痛每天都加剧,直到插入硬膜外导管。她的估计肾小球滤过率(eGFR)和血细胞比容恶化,随后进行了择期剖宫产。

结论

硬膜外镇痛仅提供了几天的疼痛缓解。当孕妇出现腔静脉后输尿管并伴有严重疼痛时,在评估复杂的病情和胎儿大小后应考虑短期硬膜外镇痛。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b14a/6966975/d5d1cc6785a6/40981_2019_271_Fig1_HTML.jpg

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