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脊髓损伤患者双侧球结膜下出血:病例报告。

Bilateral subconjunctival haemorrhage in spinal cord injury: a case report.

机构信息

Department of Rehabilitation, Tianjin Hospital, Tianjin, China.

Department of Medicine, Tianshi College, Tianjin, China.

出版信息

J Int Med Res. 2023 Aug;51(8):3000605231190547. doi: 10.1177/03000605231190547.

Abstract

Neurogenic lower urinary tract dysfunction is a common symptom after spinal cord injury. Here, the case of a 45-year-old male patient who was treated with indwelling urinary catheter during spinal surgery for a fall fracture injury of the T12 thoracic vertebra, associated with decreased muscle strength of both lower extremities, is described. During hospitalization in the rehabilitation department, conventional anticoagulation therapy was administered, and the urinary catheter was removed with the patient urinating by increasing abdominal pressure. At 8 days following urinary catheter removal, the patient was found to have a slight subconjunctival haemorrhage of the left eye, which gradually developed into massive subconjunctival haemorrhage in both eyes. After re-indwelling the urinary catheter, the bilateral subconjunctival haemorrhage gradually improved. No abnormal indicators were found during re-examination of coagulation function and platelet count, and the results of ophthalmological examination were normal. For patients with neurogenic bladder dysfunction associated with spinal cord injury, the risk of bleeding during the anticoagulation period should be carefully assessed to eliminate possible underlying bleeding risk factors (including past medical history and appropriate use of anticoagulant drugs) when considering spontaneous urination through the mode of abdominal pressure.

摘要

神经源性下尿路功能障碍是脊髓损伤后的常见症状。本文报道了 1 例 45 岁男性患者,因 T12 胸椎坠落性骨折损伤行脊柱手术时留置导尿管,同时伴有双下肢肌力下降。在康复科住院期间,给予常规抗凝治疗,患者通过增加腹压排尿拔除导尿管。拔除导尿管后 8 天,患者发现左眼轻度结膜下出血,逐渐发展为双眼大量结膜下出血。再次留置导尿管后,双侧结膜下出血逐渐改善。复查凝血功能和血小板计数未见异常指标,眼科检查结果正常。对于伴有脊髓损伤的神经源性膀胱功能障碍患者,在考虑通过腹部压力自主排尿时,应仔细评估抗凝期间出血的风险,以消除可能的潜在出血风险因素(包括既往病史和适当使用抗凝药物)。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4e7b/10402281/4adb4efe383b/10.1177_03000605231190547-fig1.jpg

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