脊髓灰质炎产妇分娩期间的麻醉及产科管理：病例分析及系统回顾
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Anesthetic and Obstetric Management of Syringomyelia During Labor and Delivery: A Case Series and Systematic Review
背景与目的
脊髓灰质炎是一种罕见的，缓慢进展的神经系统疾病，其特征在于脊髓内存在着syrinx。关于脊髓灰质炎产妇最安全的分娩和麻醉管理方式的共识仍然存在争议。本研究回顾性观察了我院脊髓灰质炎病例，并对大量文献进行了系统的综述，以提供分娩期麻醉管理的措施。
方 法
对我院2002年至2014年的病例进行了回顾性分析，并对1946年至2014年的相关文献进行了系统性综述。住院病历和电子数据库均使用国际疾病分类名称，搜索第10修订版丛书的关键词“脊髓空洞症”，“延髓空洞症”和“怀孕”。数据记录有关内容为:患者数量，疾病诊断，放射学报告，神经系统症状，分娩方式，麻醉管理措施和产妇及婴儿的预后
结 果
收集和分析了39例患者共43次分娩的有关数据数据。 syrinx最常见的位置为胸段脊髓（41.9％）。大多数患者（n = 34; 87％）在分娩前出现与脊髓空洞症相关的症状。49%的新生儿发生Arnold –Chiari畸形。全麻是最常用的（n = 21/30，70％）麻醉方式。大多数患者（n = 9 / 13,69％）使用硬膜外阻滞镇痛，未出现椎管内麻醉相关的母体或新生儿并发症。但是，3例（14％）出现全麻并发症，包括气管插管困难，产后神经症状暂时性恶化，以及阿曲库铵使用延长的长时间肌肉麻痹。
结 论
尽管担心阴道分娩会加重脊髓空洞症的发生，但这种分娩方式从未导致神经系统疾病的长时期恶化。所有的麻醉方式均可成功施行，且不会出现严重的持续性并发症。所有孕期妇女都需要进行针对性的咨询和个性化的多学科诊疗，以确保安全性。
原始文献摘要
Gráinne Patricia Garvey, Vibhangini S. Wasade, Kellie E. Murphy, and Mrinalini Balki；Anesth Analg 2017;125:913–24；Anesthetic and Obstetric Management of Syringomyelia During Labor and Delivery: A Case Series and Systematic Review
BACKGROUND: Syringomyelia is a rare, slowly progressive neurological condition characterized by the presence of a syrinx within the spinal cord. Consensus regarding the safest mode of delivery and anesthetic management in patients with syringomyelia remains controversial and presents management dilemmas. This study reviews the cases of syringomyelia at our institution and provides a systematic review of the literature to guide decisions regarding labor and delivery management.
METHODS: A retrospective review of cases at our hospital from 2002 to 2014 and a systematic review of the literature from 1946 to 2014 were undertaken. Hospital records and electronic databases were interrogated using International Classification of Diseases, 10th Revision codes and the keywords “syringomyelia,” “syringobulbia,” and “pregnancy.” Data regarding demographics,diagnosis, radiology reports, neurological symptoms, mode of delivery, anesthetic management,and maternal-fetal outcomes were collected.
RESULTS: We collected and analyzed data on a total of 43 pregnancies in 39 patients. The most common location for syrinx was in the cervicothoracic region (41.9%). The large majority of patients (n = 34; 87%) demonstrated signs and symptoms associated with syringomyelia before delivery. Syringomyelia associated with Arnold Chiari malformation was documented in 49% (n = 21) cases. General anesthesia was the most commonly used (n = 21/30, 70%) anesthetic technique for cesarean delivery. The majority (n = 9/13, 69%) of patients had an epidural sited for labor analgesia. There were no maternal or neonatal complications associated with neuraxial
anesthesia; however, 3 cases (14%) raised concerns regarding general anesthesia including difficult intubation, transient worsening of neurological symptoms postpartum, and prolonged muscle paralysis after atracurium.
CONCLUSIONS: Despite concerns regarding aggravation of the syrinx with vaginal delivery, this mode of delivery has never caused any documented long-term worsening of neurological condition. All techniques of anesthesia have been performed successfully without major lasting complications. All cases necessitate patient counseling and individualized multidisciplinary involvement to ensure maternal safety.
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