Tamakawa S, Ogawa H
Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical College.
Masui. 1998 May;47(5):593-5.
We present a case of epidural hematoma in a liver cirrhosis patient with a depressed platelet count but normal prothrombin and activated thromboplastin times. A 60-year-old woman hospitalized with liver cirrhosis was referred to us for low back pain. She suffered the fracture of the body of the 12 th thoracic vertebra in a fall. Her platelet count was below normal ranges, but, other coagulation tests were within normal ranges. We inserted an 18-gauge epidural catheter at Th 12-L1 interspace. Twenty-one days later, paresis and hypesthesia in both legs, and a loss of sphincter function occurred. Magnetic resonance imaging revealed a posteriorly placed hematoma extending from Th 12 to L1. Considering the hemorrhagic tendency and hepatic insufficiency, we did not perform laminectomy. After 4 days, the patient's strength began to recover, and after 7 days paresis and hypesthesia improved. We should avoid performing epidural catheterization to improve chronic pain for a patient with liver cirrhosis if his or her platelet count is below 100,000.mm-3.
我们报告一例肝硬化患者发生硬膜外血肿的病例，该患者血小板计数降低，但凝血酶原时间和活化部分凝血活酶时间正常。一名因肝硬化住院的60岁女性因腰痛转诊至我院。她在一次跌倒中发生了第12胸椎椎体骨折。她的血小板计数低于正常范围，但其他凝血检查结果在正常范围内。我们在第12胸椎至第1腰椎间隙插入了一根18号硬膜外导管。21天后，患者出现双下肢无力、感觉减退以及括约肌功能丧失。磁共振成像显示硬膜外血肿位于后方，从第12胸椎延伸至第1腰椎。考虑到出血倾向和肝功能不全，我们未进行椎板切除术。4天后，患者的肌力开始恢复，7天后无力和感觉减退症状有所改善。对于血小板计数低于100,000/mm³的肝硬化患者，为改善慢性疼痛而进行硬膜外导管插入术时应谨慎。
