Risks of Regional Anesthesia—Infectious, Septic
Risks of Regional Anesthesia—Infectious, Septic
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区域麻醉的风险——感染性、败血症
DOI：
10.1136/rapm-00115550-199621061-00013
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发表时间：
1996
影响因子：
5.1
通讯作者：
T. Horlocker
中科院分区：
文献类型：
--
作者：
D. Wedel;T. Horlocker
幸运的是，神经阻滞的感染性并发症非常罕见。可能的风险因素包括潜在的败血症、糖尿病、免疫状态低下、类固醇治疗、局部细菌生长或感染以及长期导管维护。脊髓附近的细菌感染可表现为脑膜炎或继发于脓肿形成的脊髓压迫。该来源可以是外源性的，由于污染的设备或药物，或内源性继发于患者体内存在的细菌来源，接种到针或导管放置部位。留置导管也可能受到皮肤或皮下组织表面细菌部位或住院患者医院来源的污染。理论上，连续导管可作为从皮肤表面向硬膜外腔传播感染的芯。在超过65，000种脊髓麻醉剂的组合系列中，只有三例脑膜炎。对大约50，000种硬膜外麻醉剂的类似审查未能发现单一硬膜外或鞘内感染[1]。很少有数据表明，在菌血症期间，脊髓或硬膜外麻醉是中枢神经轴感染的危险因素。虽然在先前的研究中没有报告在针头插入时发热的患者数量，但这些研究中纳入的大量患者接受了产科或泌尿外科手术，并且很可能一些患者在针头或导管放置后（或期间）发生了菌血症。尽管区域麻醉后中枢神经系统感染的风险明显较低，但麻醉师长期以来一直认为脓毒症是腰麻或硬膜外麻醉的相对禁忌症。这种印象很大程度上是基于轶事报告以及相互矛盾的实验室和临床研究。
Infectious complications of neural block are fortunately extremely rare. Possible risk factors include underlying sepsis, diabetes, depressed immune status, steroid treatment, localized bacte-rial growth or infection, and long-term catheter maintenance. Bacterial infection in the vicinity of the spinal cord can present as meningitis or cord compression secondary to abscess formation. The source can be exogenous due to contaminated equipment or drugs or endogenous secondary to a bacterial source present in the patient, with seeding to the site of needle or catheter placement. Indwelling catheters may also be contaminated from a superficial bacterial site in the skin or subcu-taneous tissues or from a nosocomial source in the hospitalized patient. Continuous catheters can the-oretically serve as wicks for the spread of infection from the surface of the skin to the epidural space. In a combined series of more than 65,000 spinal anesthetics, there were only three cases of menin-gitis. A similar review of approximately 50,000 epidural anesthetics failed to disclose a single epidural or intrathecal infection (1). Few data suggest that spinal or epidural anesthesia during bac-teremia is a risk factor for infection of the central neural axis. Although the number of patients who vvere febrile at the time of needle insertion is not reported in the previous studies, a significant num-ber of the patients included in these studies under-went obstetric or urologic procedures, and it is likely that some patients had bacteremia after (and perhaps during) needle or catheter placement. Despite the apparent low risk of central nervous system infection following regional anesthesia, anesthesiologists have long considered sepsis to be a relative contraindication to the administration of spinal or epidural anesthesia. This impression is based largely on anecdotal reports and conflicting laboratory and clinical investigations.