上海交通大学学报（医学版）

上海交通大学学报（医学版）

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产妇腰段硬膜外阻滞并发霍纳综合征的临床分析

徐振东，刘志强   

  1. 同济大学附属第一妇婴保健院麻醉科， 上海 200040
  • 出版日期:2013-11-28 发布日期:2013-12-03
  • 通讯作者: 刘志强, 电子信箱: drliuzhq@hotmail.com。
  • 作者简介:徐振东（1976—）， 男， 主治医师， 硕士; 电子信箱: btxzd123@126.com。

Analysis of Horner's syndrome following lumbar epidural blocking for caesarean section

XU Zhen-dong, LIU Zhi-qiang   

  1. Department of Anesthesiology, Shanghai First Maternity and Infant Health Hospital, Tongji University, Shanghai 200040, China
  • Online:2013-11-28 Published:2013-12-03

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摘要：

目的 探讨腰段硬膜外阻滞并发霍纳综合征(HS)的可能原因、危害及处理。方法 分析硬膜外阻滞后发生HS的3例剖宫产产妇的临床资料。结果 3例产妇在行腰段硬膜外阻滞后约40 min出现一侧眼睑下垂和瞳孔缩小等HS的表现。3例产妇循环稳定，1例有轻度呼吸困难。新生儿评分在正常范围。HS的症状在发生后约2 h完全消退，未予特殊干预。结论 腰段硬膜外阻滞并发HS可能是由于产妇硬膜外腔减小，腹压增高，使局部麻醉药液向头端扩散；也与交感神经对局部麻醉药的高敏有关。HS对患者危害较小，发生HS后应严密观察循环、呼吸情况，做好应对准备。

关键词: 硬膜外阻滞, 霍纳综合征, 剖宫产

Abstract:

Objective To explore the mechanism, adverse effects, and management of Horner's syndrome (HS) following lumbar epidural blocking. Methods The clinical data of 3 parturients under caesarean section with HS after lumbar epidural blocking were analyzed. Results HS symptoms, such as lateral ptosis and miosis, were noted in 3 parturients 40 min after lumbar epidural blocking. The hemodynamic parameters of all 3 parturients were stable, and mild dyspnea occurred in one. The Apgar scores of neonates were normal. The symptoms spontaneously regressed 2 h later without any intervention. Conclusion The plausible mechanism for the development of HS associated with epidural blocking is the cephalad spread of local anesthesia, which may result from the decreased capacity of epidural space and increased intra-abdominal pressure of pregnant women. Sympathetic fiber hypersensitivity may also contribute to HS. HS as a complication of lumbar epidural blocking is usually benign and spontaneously reversible. These patients with HS should be monitored closely for autonomic complications.

Key words: epidural blocking, Horner's syndrome, caesarean section