Bernhardt A, Kortgen A, Niesel H Ch, Goertz A
Abteilung für Anästhesie, Operative Intensivmedizin und Schmerztherapie St. Marien- und Annastiftskrankenhaus Ludwigshafen/Rhein.
Anaesthesiol Reanim. 2002;27(1):16-22.
According to a previous study, an excellent level of analgesia can be expected when using epidural anaesthesia in patients with acute pancreatitis. In the present investigation, the effectiveness and safety of epidural anaesthesia is demonstrated in a large group of patients with severe acute pancreatitis, who were admitted to an intensive care unit. Epidural anaesthesia alone produced excellent analgesia on 1,083 of 1,496 observation days (72%) without the systemic use of other analgesic substances. Even in patients with marginal cardiovascular stability, epidural injection of local anaesthetic solution was tolerated well. Only 8% of all local anaesthetic injections were associated with a haemodynamic reaction that required pharmacological intervention. There was no case of a septic or neurological complication of epidural anaesthesia. Initially elevated serum amylase and lipase were normalized after 17.4 days (minimum one day, maximum 19 days). Surgical intervention was necessary for 36 patients, with a total of 64 surgeries having to be performed, including cholecystectomy. Sixteen patients required artificial ventilation for an average time of 12.3 days (minimum two days, maximum 48 days). Lethality was 2.5% (three patients), with all three patients suffering from an acute stage III pancreatitis. The average duration of ICU treatment was 12.4 days (minimum two days, maximum 101 days).
根据先前的一项研究，在急性胰腺炎患者中使用硬膜外麻醉时可预期达到良好的镇痛效果。在本研究中，硬膜外麻醉的有效性和安全性在一大组入住重症监护病房的重症急性胰腺炎患者中得到了证实。在1496个观察日中，仅硬膜外麻醉就在1083日（72%）产生了良好的镇痛效果，且未全身使用其他镇痛药物。即使在心血管稳定性处于临界状态的患者中，硬膜外注射局部麻醉溶液的耐受性也良好。所有局部麻醉注射中只有8%与需要药物干预的血流动力学反应相关。硬膜外麻醉没有发生感染或神经并发症的病例。最初升高的血清淀粉酶和脂肪酶在17.4天后（最短1天，最长19天）恢复正常。36例患者需要进行手术干预，总共进行了64次手术，包括胆囊切除术。16例患者需要人工通气，平均时间为12.3天（最短2天，最长48天）。死亡率为2.5%（3例患者），所有3例患者均患有急性III期胰腺炎。ICU治疗的平均持续时间为12.4天（最短2天，最长101天）。
