Sadowski Samira M, Andres Axel, Morel Philippe, Schiffer Eduardo, Frossard Jean-Louis, Platon Alexandra, Poletti Pierre-Alexandre, Bühler Leo
Samira M Sadowski, Axel Andres, Philippe Morel, Leo Bühler, Department of Visceral and Transplantation Surgery, University Hospitals of Geneva, 1211 Geneva 14, Switzerland.
World J Gastroenterol. 2015 Nov 21;21(43):12448-56. doi: 10.3748/wjg.v21.i43.12448.
To study the safety of epidural anesthesia (EA), its effect on pancreatic perfusion and the outcome of patients with acute pancreatitis (AP).
From 2005 to August 2010, patients with predicted severe AP [Ranson score ≥ 2, C-reactive protein > 100 or necrosis on computed tomography (CT)] were prospectively randomized to either a group receiving EA or a control group treated by patient controlled intravenous analgesia. Pain management was evaluated in the two groups every eight hours using the visual analog pain scale (VAS). Parameters for clinical severity such as length of hospital stay, use of antibiotics, admission to the intensive care unit, radiological/clinical complications and the need for surgical necrosectomy including biochemical data were recorded. A CT scan using a perfusion protocol was performed on admission and at 72 h to evaluate pancreatic blood flow. A significant variation in blood flow was defined as a 20% difference in pancreatic perfusion between admission and 72 h and was measured in the head, body and tail of the pancreas.
We enrolled 35 patients. Thirteen were randomized to the EA group and 22 to the control group. There were no differences in demographic characteristics between the two groups. The Balthazar radiological severity score on admission was higher in the EA group than in the control group (mean score 4.15 ± 2.54 vs 3.38 ± 1.75, respectively, P = 0.347) and the median Ranson scores were 3.4 and 2.7 respectively (P = NS). The median duration of EA was 5.7 d, and no complications of the epidural procedure were reported. An improvement in perfusion of the pancreas was observed in 13/30 (43%) of measurements in the EA group vs 2/27 (7%) in the control group (P = 0.0025). Necrosectomy was performed in 1/13 patients in the EA group vs 4/22 patients in the control group (P = 0.63). The VAS improved during the first ten days in the EA group compared to the control group (0.2 vs 2.33, P = 0.034 at 10 d). Length of stay and mortality were not statistically different between the 2 groups (26 d vs 30 d, P = 0.65, and 0% for both respectively).
Our study demonstrates that EA increases arterial perfusion of the pancreas and improves the clinical outcome of patients with AP.
研究硬膜外麻醉（EA）的安全性、其对胰腺灌注的影响以及急性胰腺炎（AP）患者的预后。
2005年至2010年8月，将预测为重症AP（兰森评分≥2、C反应蛋白>100或计算机断层扫描（CT）显示坏死）的患者前瞻性随机分为接受EA的组和采用患者自控静脉镇痛治疗的对照组。每8小时使用视觉模拟疼痛量表（VAS）对两组的疼痛管理进行评估。记录临床严重程度参数，如住院时间、抗生素使用情况、入住重症监护病房情况、放射学/临床并发症以及包括生化数据在内的手术坏死清创术需求。入院时和72小时时进行采用灌注方案的CT扫描以评估胰腺血流。血流的显著变化定义为入院时和72小时时胰腺灌注相差20%，并在胰腺的头部、体部和尾部进行测量。
我们纳入了35例患者。13例被随机分配到EA组，22例被分配到对照组。两组的人口统计学特征无差异。EA组入院时的巴尔萨泽放射学严重程度评分高于对照组（平均评分分别为4.15±2.54和3.38±1.75，P = 0.347），兰森评分中位数分别为3.4和2.7（P = 无统计学意义）。EA的中位持续时间为5.7天，未报告硬膜外操作的并发症。EA组13/30（43%）的测量显示胰腺灌注改善，而对照组为2/27（7%）（P = 0.0025）。EA组1/13例患者进行了坏死清创术，对照组为4/22例患者（P = 0.63）。与对照组相比，EA组在前10天VAS有所改善（10天时为0.2对2.33，P = 0.034）。两组的住院时间和死亡率无统计学差异（分别为26天对30天，P = 0.65，两组均为0%）。
我们的研究表明，EA可增加胰腺的动脉灌注并改善AP患者的临床预后。
