Ulke Zerrin Sungur, Sentürk Mert
Istanbul Faculty of Medicine, Department of Anesthesiology, Turkey.
Agri. 2007 Apr;19(2):6-12.
Thoracic epidural anaesthesia is selected usually to provide adequate postoperative analgesia; however with administration of local anaesthetics to epidural space selective sympatolysis ensues. The effects of this transient sympathectomy on cardivascular, respiratory and other systems deserve certainly some interest as it may influence postoperative morbidity or mortality. Thoracic epidural anaesthesia has succesfully been used in cardiac, thoracic and major abdominal surgery. It provides dynamic analgesia, rapid mobilization, blunted stress response, early extubation with reduced pulmonary complications and also rapid recovery of bowel function. In cardiac surgery where thoracic sympathetic blockade is expected to be most useful, there is no difference in morbidity and mortality. Despite the superior quality of pain control, the beneficial aspect of thoracic epidural anaesthesia is not reflected on outcome in meta-analysis. Recent papers has still demonstrated positive effects on each system. So thoracic epidural anaesthesia is increasingly used and it seems that it will be discussed more in near future.
胸段硬膜外麻醉通常用于提供充分的术后镇痛；然而，在硬膜外间隙给予局部麻醉药后会发生选择性交感神经阻滞。这种短暂性交感神经切除术对心血管、呼吸及其他系统的影响无疑值得关注，因为它可能会影响术后发病率或死亡率。胸段硬膜外麻醉已成功应用于心脏、胸部及腹部大手术。它可提供动态镇痛、快速活动能力恢复、减轻应激反应、早期拔管并减少肺部并发症，还能使肠功能快速恢复。在预计胸段交感神经阻滞最有用的心脏手术中，发病率和死亡率并无差异。尽管在疼痛控制方面质量更优，但胸段硬膜外麻醉的有益之处在荟萃分析中并未体现在结局上。近期的论文仍表明其对各个系统有积极作用。因此，胸段硬膜外麻醉的应用越来越广泛，而且似乎在不久的将来会得到更多讨论。
