硬膜外鎮痛を用いて分娩管理を行った脊髄損傷合併妊娠の1症例

The Obstetric Anesthetic Management of a Woman with a High Spinal Cord Injury

要旨

　32歳（170cm，非妊時体重61kg，初産）の高位脊髄損傷妊婦に対し，硬膜外鎮痛を導入し，その後胎児機能不全により硬膜外麻酔によって緊急帝王切開術を施行した。脊髄損傷患者の分娩においては自律神経過反射の発生予防が重要であり，硬膜外麻酔を用いて周産期合併症の発生なく管理することができた。

　We describe the details of the obstetric anesthetic management of a 32-year-old woman with a spinal cord injury she had incurred as a young teenager that resulted in paraplegia below the C5/6 level. We initiated an epidural analgesic delivery without complications；however, due to a non-reassuring fetal status of unknown origin, an emergency cesarean section was performed 73 minutes after the epidural anesthesia was administered. The operation was successfully completed using epidural anesthesia. This case highlights the importance of preventing autonomic hyperreflexia during the delivery process for women with a spinal cord injury. Our patient’s delivery was successfully managed with only the use of epidural anesthesia.