Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, GReD, Clermont-Ferrand, France.
Crit Care Med. 2018 Mar;46(3):e198-e205. doi: 10.1097/CCM.0000000000002874.
Recent preclinical and clinical data suggest that thoracic epidural analgesia, a technique primarily aimed at decreasing pain, might exert anti-inflammatory effects, enhance splanchnic and pancreatic blood flow during acute pancreatitis; however, the influence of epidural analgesia on mortality remains under investigated in this setting. This study was therefore designed to assess the impact of epidural analgesia on mortality in ICU patients with acute pancreatitis.
Multicenter retrospective, observational, cohort study.
Seventeen French and Belgian ICUs.
All patients admitted to with acute pancreatitis between June 2009 and March 2014.
The primary exposure was thoracic epidural analgesia versus standard care without epidural analgesia. The primary outcome was 30-day mortality. Propensity analyses were used to control for bias in treatment assignment and prognostic imbalances.
One thousand three ICU patients with acute pancreatitis were enrolled, of whom 212 died within 30 days. Epidural analgesia was used in 46 patients and was associated with reduced mortality in unadjusted analyses (4% vs. 22%; p = 0.003). After adjustment for baseline variables associated with mortality, epidural analgesia was still an independent predictor of 30-day mortality (adjusted odds ratio, 0.10; [95% CI, 0.02-0.49]; p = 0.004). Using propensity score analysis, the risk of all-cause 30-day mortality in patients with acute pancreatitis receiving epidural analgesia was significantly lower than that in matched patients who did not receive epidural analgesia (2% vs. 17%; p = 0.01).
Among critically ill patients with acute pancreatitis, mortality at 30 days was lower in patients who received epidural analgesia than in comparable patients who did not. These findings support ongoing research on the use of epidural analgesia as a therapeutic intervention in acute pancreatitis.
最近的临床前和临床数据表明，胸段硬膜外镇痛技术主要用于减轻疼痛，可能具有抗炎作用，增强急性胰腺炎时内脏和胰腺的血流；然而，在这种情况下，硬膜外镇痛对死亡率的影响仍有待研究。因此，本研究旨在评估硬膜外镇痛对 ICU 急性胰腺炎患者死亡率的影响。
多中心回顾性、观察性、队列研究。
法国和比利时的 17 个 ICU。
2009 年 6 月至 2014 年 3 月期间收治的所有急性胰腺炎患者。
主要暴露因素为胸段硬膜外镇痛与无硬膜外镇痛的标准治疗。主要结局为 30 天死亡率。采用倾向分析来控制治疗分配和预后失衡的偏倚。
共纳入 1300 例 ICU 急性胰腺炎患者，其中 212 例在 30 天内死亡。46 例患者接受了硬膜外镇痛，在未调整分析中死亡率降低（4%比 22%；p=0.003）。在调整与死亡率相关的基线变量后，硬膜外镇痛仍然是 30 天死亡率的独立预测因素（调整后的优势比，0.10；[95%CI，0.02-0.49]；p=0.004）。使用倾向评分分析，接受硬膜外镇痛的急性胰腺炎患者的全因 30 天死亡率明显低于未接受硬膜外镇痛的匹配患者（2%比 17%；p=0.01）。
在患有急性胰腺炎的危重症患者中，接受硬膜外镇痛的患者 30 天死亡率低于未接受硬膜外镇痛的可比患者。这些发现支持了关于将硬膜外镇痛作为急性胰腺炎治疗干预措施的研究。
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