Pottecher Julien, Falcoz Pierre-Emmanuel, Massard Gilbert, Dupeyron Jean-Pierre
Department of Anesthesiology and Critical Care Medicine, University Hospital, Strasbourg, France.
Interact Cardiovasc Thorac Surg. 2011 Jan;12(1):51-3. doi: 10.1510/icvts.2010.241489. Epub 2010 Oct 11.
A best evidence topic was constructed according to a structured protocol. The question addressed was whether the use of preoperative or early postoperative thoracic epidural analgesia (TEA) is effective in improving outcomes--reducing duration of mechanical ventilation, intensive care unit (ICU) length of stay and respiratory complications--in patients undergoing lung transplantation (LTx). Of the 42 papers found using a report search, five presented the best evidence to answer the clinical question. The authors, journal, date and country of publication, study type, group studied, relevant outcomes and results of these papers are given. We conclude that, on the whole, four out of the five retrieved studies clearly supported the use of TEA as the cornerstone of a multi-faceted strategy for improving outcomes after LTx. Indeed, the interest and benefit was shown not only in terms of duration of mechanical ventilation, but also in reducing the ICU length of stay and the number of respiratory complications. Hence, current evidence suggests TEA to be safe and effective in alleviating postoperative pain and in improving patient recovery, thus enhancing the choice of available medical care and bettering outcome after LTx. However, given the low level of evidence of published studies, prospective trials are warranted to confirm those encouraging results.
根据结构化方案构建了一个最佳证据主题。所探讨的问题是，对于接受肺移植（LTx）的患者，术前或术后早期使用胸段硬膜外镇痛（TEA）在改善预后（缩短机械通气时间、重症监护病房（ICU）住院时长和减少呼吸并发症）方面是否有效。在通过报告检索找到的42篇论文中，有5篇提供了回答该临床问题的最佳证据。文中给出了这些论文的作者、期刊、出版日期和国家、研究类型、研究组、相关结局及结果。我们得出结论，总体而言，5项检索到的研究中有4项明确支持将TEA作为改善LTx术后预后的多方面策略的基石。实际上，不仅在机械通气时长方面显示出益处，在缩短ICU住院时长和减少呼吸并发症数量方面也有体现。因此，目前的证据表明TEA在减轻术后疼痛和改善患者恢复方面安全有效，从而增加了可用医疗护理的选择并改善了LTx后的结局。然而，鉴于已发表研究的证据水平较低，有必要进行前瞻性试验来证实这些令人鼓舞的结果。
