沒有凝血功能異常的病人在硬脊膜上腔麻醉後產生硬脊膜上腔血腫之病例報告

Spinal Epidural Hematoma after Epidural Anesthesia in a Patient without Coagulopathy

使用硬脊膜上腔麻醉而產生脊椎硬脊膜上腔血腫並且有神經功能缺損的機會並不大，大多發生在有使用抗凝血劑或本身有凝血功能異常的病人。在此我們提出一個52歲女性沒有凝血功能異常的病人，在硬脊膜上腔麻醉後產生脊椎硬脊膜上腔血腫之病例報告，其神經學方面的表現包括下肢麻木無力，尿失禁以及有陽性Barb旭ski’s表徵。影像學檢查發現有胸腰椎椎間盤突出以及在Tl2-L3有硬脊膜上腔血塊。在緊急做椎板切除術及移除硬膜上血塊後，病人的神經學症狀得以逐漸恢復，術後追蹤4個月，病人可獨立行走，無須輔助工具。我們認為本案例可能是因為硬脊膜上腔導管放置困難產生血腫塊以及病人同時有脊椎椎管狹窄的情況，因而使硬脊膜上腔血塊造成脊髓壓迫而產生神經功能受損的情況。

Spinal epidural hematoma with neurological deficits following epidural anesthesia is rare. Risk factors for spinal epidural hematoma included bloody tap, preexisting coagulopathy, and use of anticoagulants. We report a case of spinal epidural hematoma with neurological deficits after epidural anesthesia for laparotomy in a gynecological patient without coagulopathy. The neurological manifestation included lower leg numbness and weakness, urinary incontinence, and positive Barbinski' s sign. The radiological finding suggested thoracolumbar spondylosis and disc bulging, and epidural hematoma over T12-L3. The symptoms improved after an emergent laminectomy and removing epidural hematoma was performed. The patient can walk without a walking stick four months later. We suspect that the difficulty during epidural catheter insertion caused the epidural hematoma. The thoracolumbar spondylosis of the patient may contribute to the neurologic deficits caused by the epidural hematoma.