高位截瘫孕妇围术期管理1例报告

One Case Report of Perioperative Management of Pregnant Women with High Paraplegia

目前国内外高位截瘫孕妇围产期管理经验十分有限。患者截瘫平面以下感觉及运动能力丧失,无法感知宫缩和胎动等,只能依靠医护人员来监测。虽然截瘫孕妇顺产、剖宫产都感觉不到疼痛,但是脊髓损伤平面以下未受到下丘脑的控制,当受到手术、疼痛、大小便潴留、体位变化、不适等不良刺激时极易导致自主性反射亢进,典型表现是突发严重的高血压,意识丧失,心率失常,脑出血,甚至死亡。因此,高位截瘫孕妇围产期需要严密监护,尽量避免不良刺激,以免诱发自主性反射亢进,警惕产后出血及血栓栓塞风险,产后充分镇痛镇静,方能顺利渡过围产期。

At present,the experience of perinatal management of pregnant women with high paraplegia at home and abroad is very limited.Patients with loss of sensation and movement below the paraplegic plane,unable to sense contractions,fetal move-ments,etc.can only rely on medical staff to monitor.W hen subjected to adverse stimuli such as surgery,pain,urinary and fecal re-tention,postural changes,discomfort,etc,it is easy to cause autonomous reflexes hyperactivity,the typical manifestations are sud-den severe hypertension,loss of consciousness,arrhythmia,cerebral hemorrhage,and even death.In summary,pregnant women with high paraplegia need close monitoring during the perinatal period,avoid adverse stimuli as much as possible,so as not to induce autonomic hyperreflexia,be alert to the risk of postpartum hemorrhage and thromboembolism,and adequate analgesia and se-dation after delivery can pass the perinatal period smoothly.