颅内破裂动脉瘤介入栓塞术后抗凝及抗血小板聚集药物应用下腰椎穿刺致急性椎管内血肿2例并文献复习

目的探讨腰椎穿刺(LP)导致椎管内血肿(ISH)形成的临床表现、诊断、治疗及预后。方法 回顾性分析新乡医学院第一附属医院2020年7月—2020年10月收治的2例在使用抗血小板聚集及抗凝药物情况下LP导致急性ISH形成患者的临床资料，并复习相关文献。结果此2例均为脑动脉瘤破裂合并蛛网膜下腔出血患者，在支架辅助弹簧圈栓塞动脉瘤术后使用抗血小板聚集及抗凝药物预防支架内血栓形成。在行LP术后均出现急性ISH，并进一步行血肿清除及椎管减压术治疗，出院时均遗留不同程度的神经功能障碍。结论抗凝及抗血小板聚集药物的应用使LP导致ISH形成的可能性较前增加。其诊断主要依靠患者的临床表现、体征及影像学检查，治疗以外科手术减压为主，预后主要与发病时神经功能缺失的程度相关。

Objective To investigate the clinical manifestations, diagnosis, treatment and prognosis of intraspinal hematoma(ISH) caused by lumbar puncture(LP). Methods The clinical data of 2 patients admitted to The First Affiliated Hospital of Xinxiang Medical College from July 2020 to October 2020 with acute ISH caused by LP in the presence of antiplatelet and anticoagulant drugs were analyzed retrospectively, and the relevant literature were reviewed. Results Both cases had ruptured cerebral aneurysms complicated with subarachnoid hemorrhage, in which the antiplatelet aggregation and anticoagulant drugs were used to prevent stent thrombosis after the stent-assisted coil embolization of aneurysms. Acute ISH occurred in the 2 patients after LP, and further hematoma removal and spinal decompression were performed. Both cases were discharged with varying degrees of neurological dysfunction. Conclusions With the application of anticoagulant and antiplatelet aggregation drugs, LP is more likely to lead to the formation of ISH. The diagnosis mainly depends on the clinical manifestations, signs and imaging examination of the patients. The treatment is mainly surgical decompression, and the prognosis is mainly related to the degree of neurological function loss at the onset.