Du Pen S L, Peterson D G, Williams A, Bogosian A J
Department of Anesthesiology, Swedish Hospital Medical Center, Seattle, Washington 98104.
Anesthesiology. 1990 Nov;73(5):905-9. doi: 10.1097/00000542-199011000-00018.
A potentially serious complication of long-term epidural catheterization in cancer patients is infection. The early signs of infection were studied in 350 patients in whom long-term epidural catheters were inserted. Three areas of the catheter track were found to be involved; exit site and superficial catheter track infection, and epidural space infection. The authors identified the early signs of infection in each area and the progress of the infection from the deep track to include the epidural space in four of these patients. All 19 patients who developed deep track or epidural infections were successfully treated with antibiotics and catheter removal. None of the patients required surgery for spinal cord decompression. Catheters were replaced in 15 of the 19 treated patients who requested them after treatment with no recurrent infections. It was concluded that use of long-term epidural catheterization is associated with a definable epidural infection rate. The use of epidural opioid analgesia is an effective and safe means of obtaining pain relief for terminally ill patients when patients are monitored for possible infection and receive prompt treatment when the diagnosis is established.
癌症患者长期硬膜外导管插入术的一个潜在严重并发症是感染。对350例插入长期硬膜外导管的患者的感染早期迹象进行了研究。发现导管通道的三个部位受累；出口部位和浅表导管通道感染，以及硬膜外腔感染。作者确定了每个部位感染的早期迹象，以及其中4例患者感染从深部通道发展到包括硬膜外腔的过程。所有19例发生深部通道或硬膜外感染的患者均通过使用抗生素和拔除导管成功治愈。没有患者需要进行脊髓减压手术。19例接受治疗的患者中有15例在治疗后要求更换导管，更换后无复发性感染。得出的结论是，长期硬膜外导管插入术的使用与可确定的硬膜外感染率相关。当对患者进行可能感染的监测并在确诊后立即进行及时治疗时，硬膜外阿片类药物镇痛是为晚期患者缓解疼痛的一种有效且安全的方法。
