Wulf H
Department of Anaesthesiology and Intensive Care Medicine, Hospital of the Christian-Albrechts-University of Kiel, Germany.
Can J Anaesth. 1996 Dec;43(12):1260-71. doi: 10.1007/BF03013437.
Haematoma formation in the spinal canal due to epidural anaesthesia is a very rare but serious complication. This paper presents a comprehensive review of case reports.
Sampling of case reports over a 10 yr period, medline-research (1966-1995) and cross-check with former reviews.
Fifty-one confirmed spinal haematomas associated with epidural anaesthesia were found. Most were related to the insertion of a catheter, a procedure that was graded as difficult or traumatic in 21 patients. Other risk factors were: fibrinolytic therapy (n = 2), previously unknown spinal pathology (n = 2), low molecular weight heparin (n = 2), aspirin or other NSAID (n = 3), epidural catheter inserted during general anaesthesia (n = 3), thrombocytopenia (n = 5), ankylosing spondylitis (n = 5), preexisting coagulopathy (n = 14), and intravenous heparin therapy (n = 18).
Coagulopathies or anticoagulant therapy (e.g., full heparinization) were the predominant risk factors, where-as low-dose heparin thromboprophylaxis or NSAID treatment was rarely associated with spinal bleeding complications. Ankylosing spondylitis was identified as a new, previously unreported risk factor. Analysis of reported clinical practice suggests an incidence of haematoma of 1:190,000 epidurals.
硬膜外麻醉导致椎管内血肿是一种非常罕见但严重的并发症。本文对病例报告进行了全面综述。
对10年期间的病例报告进行抽样，检索医学索引数据库（1966 - 1995年），并与以往综述进行交叉核对。
发现51例确诊的与硬膜外麻醉相关的脊髓血肿。大多数与导管插入有关，在21例患者中该操作被评为困难或有创伤性。其他危险因素包括：纤维蛋白溶解疗法（n = 2）、先前未知的脊柱病变（n = 2）、低分子量肝素（n = 2）、阿司匹林或其他非甾体抗炎药（n = 3）、全身麻醉期间插入硬膜外导管（n = 3）、血小板减少症（n = 5）、强直性脊柱炎（n = 5）、既往存在的凝血障碍（n = 14）以及静脉肝素治疗（n = 18）。
凝血障碍或抗凝治疗（如充分肝素化）是主要危险因素，而低剂量肝素预防血栓形成或非甾体抗炎药治疗很少与脊髓出血并发症相关。强直性脊柱炎被确定为一种新的、先前未报告的危险因素。对报告的临床实践分析表明，硬膜外血肿的发生率为1:190,000。
