Niesel H C, Klimpel L, Kaiser H, Bernhardt A, al-Rafai S, Lang U
Anaesthesie-Abteilung, St. Marien- und St. Annastiftskrankenhaus Ludwigshafen/Rh.
Reg Anaesth. 1991 Dec;14(6):97-100.
The effect of a fractional epidural blockade on acute pancreatitis was investigated in a prospective study. PATIENTS AND METHODS. Thoracic (20 patients) or lumbar (six patients) epidural blockade was carried out in 26 patients with severe abdominal conditions comprising sub-ileus in 100%, pancreatic edema indicated by sonography/computer tomography in 57.8%, and necrosis of the pancreas in 34.6%. RESULTS. On average, 3.4 (1-6) injections with single doses of 6-20 ml 0.25% bupivacaine were injected per day. In four patients, morphine (up to 4 mg per 24 h) was added to the local anesthetic. The duration of treatment was between 1 and 15 days. After 10.5% of the injections, the systolic pressure decreased by more than 20%, and after 12.8% of the injections the blood pressure decreased by more than 30%. Hypotension of more than 30% was treated with 0.3 to 0.5 ml theodrenaline (Akrinor) and/or 0.1 to 0.2 mg dihydro-ergotamine (Dihydergot). General analgesics had to be administered in addition on 21.8% of the treatment days and intensive care treatment (artificial ventilation) on 32% of the treatment days. The duration of epidural analgesia varied between 1 and 15 days depending on the intensity of symptoms (pain, ileus). Within 4 days, the enzyme activity of the lipase fell from 8120 to 427 IU, and that of alpha amylase fell from 1401 to 143 IU. In 3 patients laparotomy (for drainage) was performed. An ERCP was carried out in 16 patients. Cardiopulmonary failure necessitated artificial ventilation over a period of 1-15 days in 6 patients; the epidural blockade was continued during the artificial ventilation. Cholecystectomy was carried out as an interval operation in 6 patients. No neurological complications were observed. All patients survived and were discharged from hospital.
在一项前瞻性研究中，对部分硬膜外阻滞治疗急性胰腺炎的效果进行了调查。患者与方法。对26例患有严重腹部疾病的患者实施了胸段（20例）或腰段（6例）硬膜外阻滞，这些患者均存在以下情况：100%有不全肠梗阻，57.8%经超声/计算机断层扫描显示有胰腺水肿，34.6%有胰腺坏死。结果。平均每天注射3.4（1 - 6）次，单次剂量为6 - 20毫升0.25%布比卡因。4例患者在局部麻醉药中加入了吗啡（每24小时最多4毫克）。治疗持续时间为1至15天。10.5%的注射后，收缩压下降超过20%，12.8%的注射后血压下降超过30%。血压下降超过30%时，用0.3至0.5毫升去氧肾上腺素（阿克立诺）和/或0.1至0.2毫克双氢麦角胺（双氢麦角隐亭）进行治疗。在21.8%的治疗日还必须额外给予全身镇痛药，32%的治疗日需要重症监护治疗（人工通气）。硬膜外镇痛的持续时间根据症状（疼痛、肠梗阻）的严重程度在1至15天之间变化。4天内，脂肪酶的酶活性从8120降至427国际单位，α淀粉酶的酶活性从1401降至143国际单位。3例患者接受了剖腹手术（用于引流）。16例患者进行了内镜逆行胰胆管造影术。6例患者因心肺功能衰竭需要进行1至15天的人工通气；人工通气期间继续进行硬膜外阻滞。6例患者作为择期手术进行了胆囊切除术。未观察到神经并发症。所有患者均存活并出院。
