Wang L P, Schmidt J F
Neuroanaestesiologisk afdeling, H:S Rigshospitalet.
Ugeskr Laeger. 1998 May 25;160(22):3202-6.
The paper reviews the literature relevant to the formation of spinal epidural abscess with or without concurrent meningeal infection following epidural catheterisation. The incidence of spinal epidural abscess lies probably in the area of 1:5000 catheterisations. Immunocompromised patients and patients with catheters in situ for more than 48 hrs. are particularly prone to develop epidural abscesses. S. aureus is isolated in 35-82% of the cases. The diagnosis based upon clinical findings, laboratory studies and MRI or CT plus myelography. The mortality is 5-10%. The treatment consists of removal of the catheter, microbiological studies, surgical decompression of the spinal cord, and prolonged antibiotic treatment. It is suggested that insertion of epidural catheters is performed under strict sterility, and that disposable syringes and unbroken vials are used for each injection, which should be administered through an epidural filter. The dressing should be changed daily simultaneously with review of the patient and the insertion site.
本文回顾了与硬膜外导管插入术后伴或不伴并发脑膜感染的脊髓硬膜外脓肿形成相关的文献。脊髓硬膜外脓肿的发生率可能在每5000次导管插入中有1例。免疫功能低下的患者以及导管留置原位超过48小时的患者特别容易发生硬膜外脓肿。35% - 82%的病例中分离出金黄色葡萄球菌。诊断基于临床表现、实验室检查以及MRI或CT加脊髓造影。死亡率为5% - 10%。治疗包括拔除导管、微生物学检查、脊髓手术减压以及长期抗生素治疗。建议在严格无菌条件下插入硬膜外导管，每次注射使用一次性注射器和未开封的药瓶，并应通过硬膜外过滤器给药。敷料应每天更换，同时检查患者和导管插入部位。
