胸段硬膜外阻滞用于重症急性胰腺炎患者镇痛时的优势效应

Superior effects of thoracic epidural block for analgesia in patients with severe acute pancreatitis

目的:评价胸段硬膜外阻滞(TEB)用于重症急性胰腺炎患者镇痛时的优势效应。方法:重症急性胰腺炎患者50例,JSS评分≥3分,发病时间≤12 h,年龄18~64岁,性别不限,采用随机数字表法分为2组(n=25):常规镇痛组(C组)静脉输注舒芬太尼镇痛;TEB组胸段硬膜外阻滞镇痛。C组入院后静脉输注舒芬太尼0.2~0.3μg·kg^(-1)·h^(-1)。TEA组入院后于T_(9,10)间隙行硬膜外穿刺置管术,硬膜外泵注0.66%利多卡因-0.33%罗哌卡因混合液,速率3~5 ml/h,持续120 h。于镇痛1、24、48、72和120 h时记录VAS评分和腹内压(IAP);于镇痛24、72和120 h时记录HR、RR、氧合指数、CTSI评分、JSS评分和Ranson评分,评估镇痛72 h内去重症化情况。结果:与C组比较,TEB组各时点VAS评分和IAP降低,去重症化率升高,镇痛120 h时Ranson评分、CTSI评分和JSS评分降低(P<0.05)。结论:TEB用于重症急性胰腺炎的治疗,不仅具有良好的镇痛效果,还可改善疾病的发展,较常规镇痛具有明显优势效应。

Objective To evaluate the superior effect of thoracic epidural block(TEB)used for analgesia in patients with severe acute pancreatitis(SAP).Methods Fifty patients of both sexes,aged 18-64 yr,with SAP,with Japanese severity score(JSS)≥3,onset time of SAP≤12 h,were divided into conventional analgesia group(group C)and TEB group.Sufentanil was intravenously infused for analgesia in group C.TEB was performed for analgesia in group TEB.In group C,sufentanil was intravenously infused at a rate of 0.2-0.3μg·kg^(-1)·h^(-1) after admission to hospital.In group TEB,an epidural catheter was placed at T9,10 interspace,and 0.66%lidocaine mixed with 0.33%ropivacaine was epidurally infused at a rate of 3-5 ml/h for 120 h after admission to hospital.Visual analog scale(VAS)score and intra-abdominal pressure(IAP)were recorded at 1,24,48,72 and 120 h of analgesia.HR,respiratory rate(RR),oxygenation index,computed tomography severity index(CTSI),JSS and Ranson scores were recorded at 24,72 and 120 h of analgesia,and the de-criticalization within 72 h following analgesia was evaluated.Results Compared with group C,VAS score and IAP were significantly deceased at each time point(P<0.05),the rate of de-criticalization(60%/90%)was increased(P<0.05),and Ranson score,CTSI score and JSS score were decreased at 120 h of analgesia in group TEB(P<0.05).Conclusion TEB can not only produce good analgesic effect,but also improve the development of the disease,which has superior effect compared with routine analgesia when used for the treatment of SAP.