Owen M D, Stiles M M, Opper S E, McNitt J D, Fibuch E E
Department of Anesthesiology, University of Missouri-Kansas City, Saint Luke's Hospital.
Reg Anesth. 1994 Nov-Dec;19(6):415-7.
Pregnant patients with spinal cord injuries are predisposed to autonomic hyperreflexia, which if unrecognized or untreated can lead to death. Hypertension occurring in laboring patients at risk for autonomic hyperreflexia must be managed aggressively.
Epidural anesthesia can safely control autonomic hyperreflexia during labor and delivery, but because spinal cord impaired patients lack sensory and motor function below the level of injury, it is difficult to determine the dermatomal spread of epidural anesthesia by the usual methods. This difficulty is highlighted by the following case, reporting an epidural that failed during labor, with the subsequent development of autonomic hyperreflexia.
Previously, autonomic hyperreflexia occurring in pregnant patients (undergoing surgical procedures) was treated with intravenous antihypertensive agents. During labor, however, titrating these agents to coincide with uterine contractions is difficult. In this case, epidural anesthesia was repeated and the autonomic hyperreflexia resolved.
Autonomic hyperreflexia can develop in unanesthetized laboring paraplegic patients (failed epidural) but it can be successfully managed with adequate epidural anesthesia.
脊髓损伤的孕妇易发生自主神经反射亢进，若未被识别或未得到治疗，可能会导致死亡。对于有自主神经反射亢进风险的分娩患者出现的高血压，必须积极处理。
硬膜外麻醉可在分娩期间安全控制自主神经反射亢进，但由于脊髓损伤患者在损伤平面以下缺乏感觉和运动功能，通过常规方法难以确定硬膜外麻醉的皮节扩散范围。以下病例突出了这一困难，该病例报告了一例分娩期间硬膜外麻醉失败，随后发生自主神经反射亢进的情况。
以前，（接受外科手术的）孕妇发生自主神经反射亢进时，采用静脉注射抗高血压药物治疗。然而，在分娩期间，很难使这些药物的剂量调整与子宫收缩同步。在本病例中，再次进行硬膜外麻醉后，自主神经反射亢进得到缓解。
未麻醉的截瘫产妇（硬膜外麻醉失败）可发生自主神经反射亢进，但通过充分的硬膜外麻醉可成功处理。
