Kon H, Aoki M, Yamamoto S, Ikeda M, Namiki A, Ohmichi M
Division of Anesthesia, Sapporo Railway Hospital.
Kokyu To Junkan. 1990 Oct;38(10):1041-4.
A 47-year-old male suffering from an acute asthmatic attack was admitted in the morning. He was arrested on arrival. Following successful resuscitation, he was treated by using controlled ventilation with a Bennett 7200 respirator. Before starting mechanical ventilation, he was physically exhausted and had carbon dioxide retention (PaCO2 76.2 mmHg). The patient received dexamethasone 40 mg/day and theophylline 400 mg/day during the first 4 days. Despite the decrease in PaCO2 following mechanical ventilation, cycling pressure remained high (up to 50-70 cmH2O) even after 24 hours. Because of the risk of barotrauma due to high cycling pressure, we conducted cervical epidural block to reduce airway hyperreactivity to the endotracheal tube and endotracheal suctioning. Six to 10 ml of lidocaine with 1:200,000 epinephrine was administered every 1 or 2 hours. Within 4 hours after epidural block, airway pressure decreased to 30-40 cmH2O. Since then, requirements of sedative (diazepam) have decreased greatly to 10 mg/day. The patient was successfully extubated 4 days after admission. Finally, epidural block was continued for 6 days without any complication. We do not know how cervical epidural block works to reduce airway pressure. It might be beneficial to manage patients artificially ventilated during asthmatic attack.
一名47岁男性因急性哮喘发作于上午入院。他到达时已心跳骤停。成功复苏后，使用贝内特7200型呼吸机进行控制通气对其进行治疗。在开始机械通气前，他身体极度疲惫且存在二氧化碳潴留（动脉血二氧化碳分压76.2 mmHg）。患者在最初4天接受了每日40 mg地塞米松和每日400 mg茶碱的治疗。尽管机械通气后动脉血二氧化碳分压有所下降，但即使在24小时后，循环压力仍居高不下（高达50 - 70 cmH₂O）。由于高循环压力存在气压伤风险，我们进行了颈段硬膜外阻滞以降低气道对气管插管和气管内吸引的高反应性。每1或2小时给予6至10 ml含1:200,000肾上腺素的利多卡因。硬膜外阻滞后4小时内，气道压力降至30 - 40 cmH₂O。此后，镇静剂（地西泮）的需求量大幅降至每日10 mg。患者入院4天后成功拔除气管插管。最后，硬膜外阻滞持续了6天，未出现任何并发症。我们尚不清楚颈段硬膜外阻滞降低气道压力的作用机制。对于哮喘发作时接受人工通气的患者，这可能有益。
