开胸手术或胸段硬膜外麻醉后的下肢麻痹：先进行影像学检查，再提出疑问

背景当存在硬膜外导管时，出现新的运动麻痹往往归咎于局麻药的效应而使影像学检查延迟，或归咎于硬膜外血肿而忽略引起脊髓损伤的其他机制。方法一例接受开胸手术的69岁女性患者手术前留置胸段硬膜外导管以便进行手术后镇痛。结果手术中由于肋骨脊椎接合处附近出血而使用纤维素纱布和骨蜡止血。手术后患者出现麻痹，起初被误诊为局麻药的作用，而实际上是由堆积在硬膜外的纤维素纱布和骨蜡引起的。结论开胸手术或胸段硬膜外镇痛后出现新的下肢麻痹时必须进行迅速有效的影像学检查。

BACKGROUND： When an epidural catheter is present, new motor deficits will often be attributed to a local anesthetic effect, potentially delaying imaging studies, or to an epidural hematoma, ignoring other mechanisms of spinal cord injury. METHODS： A 69-yr-old female patient undergoing thoracotomy received a preoperative thoracic epidural for postoperative analgesia. RESULTS： Intraoperatively, there was bleeding near the costovertebral iunction. Hemorrhage was controlled with cellulose gauze and bone wax. Paralysis developed postoperatively and was initially misdiagnosed as a local anesthetic effect when, in fact, it was caused by an extradural deposit of ceUulose gauze and bone wax. CONCLUSIONS： We emphasize the need for prompt, definitive imaging when new lower extremity weakness develops after thoracotomy or thoracic epidural analgesia.