患者安全的事实指南:预防手术相关并发症:硬膜外脂肪瘤和产后类固醇暴露

Ryan S. D'Souza , Patricia Zheng , George Christolias , Eric K. Holder , Haewon Lee , David C. Miller , Aditya Raghunandan , Clark C. Smith , Jaymin Patel , International Pain and Spine Intervention Society's Patient Safety Committee
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引用次数: 0

摘要

本系列 "事实调查 "对证据进行了简要总结,并概述了相关建议,以增进我们对潜在手术相关并发症的了解和管理。(1)硬膜外类固醇注射治疗由脂肪瘤病引起的脊柱狭窄导致的根性疼痛 -- 有低水平证据表明硬膜外类固醇注射(ESI)与脊柱硬膜外脂肪瘤病(SEL)的发生和/或恶化有关。然而,目前还没有足够的证据证明硬膜外类固醇注射是否会单独导致脊柱狭窄的加重,并危及原有脊柱硬膜外脂肪瘤症患者的神经系统。(2) 产后类固醇暴露 -- 产后或哺乳期没有类固醇注射的绝对禁忌症,但母体和哺乳期儿童的下丘脑-垂体-肾上腺(HPA)轴对类固醇的反应可能会受到干扰。在母乳喂养期间,接触类固醇后可能会影响乳汁分泌,而在接触类固醇几小时后暂停母乳喂养可最大限度地减少婴儿接触类固醇的机会。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
FACTFINDERS for PATIENT SAFETY: Preventing procedure-related complications: Epidural lipomatosis and postpartum steroid exposure

This series of FactFinders presents a brief summary of the evidence and outlines recommendations to improve our understanding and management of potential procedure-related complications.

Evidence in support of the following facts is presented. (1) Epidural Steroid injections for Radicular Pain Due to Spinal Stenosis Caused by Lipomatosis -- There is low-level evidence of an association between epidural steroid injections (ESIs) and the development and/or worsening of spinal epidural lipomatosis (SEL). However, there is insufficient evidence to establish whether ESIs independently result in an increase in spinal stenosis with neurological compromise in individuals with pre-existing SEL. (2) Steroid Exposure Postpartum -- There is no absolute contraindication to steroid injections based on postpartum or lactating status, but there may be disruption of both maternal and breastfed child hypothalamic-pituitary-adrenal (HPA) axis response to steroid administration. For the duration of breastfeeding, milk production may be affected after steroid exposure, and withholding breast milk produced for several hours after exposure minimizes infant exposure.

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