Tyagi Asha, Gupta Yash Raj, Das Shukla, Rai Gargi, Gupta Arun
Department of Anesthesiology and Critical Care; University College of Medical Sciences and GTB Hospital, NCT of Delhi, India.
Department of Microbiology; University College of Medical Sciences and GTB Hospital, NCT of Delhi, India.
Indian J Crit Care Med. 2019 Feb;23(2):89-94. doi: 10.5005/jp-journals-10071-23123.
This preliminary randomized controlled study evaluated effect of thoracic epidural block (TEB) on progression of acute pancreatitis induced organ dysfunction/failure.
Patients with predicted severe acute pancreatitis, without contraindication to TEB were randomized to receive (group TE) or not receive a TEB (group NTE) (n = 16 each). For group TE, TEB was performed at T8-9 or T9-10 vertebral level, with infusion of ropivacaine (0.2%) along with fentanyl 2 µg/mL; in group NTE, intravenous morphine was used instead, both interventions titrated to NRS of <4. SOFA score was assessed daily till discharge from ICU, and aggregate SOFA calculated by summing worst scores for each of organ system during ICU stay as primary outcome measure. Other surrogate measures of patient outcome were recorded as secondary objectives.
Aggregate SOFA score was statistically similar between both groups (group NTE: 3 [2 - 4]; group TE: 5 [2 - 6]) ( = 0.379); but there was trend of improvement in SOFA score in group TE versus a worsening in group NTE. Duration of hospital stay, and number of patients requiring mechanical ventilation were statistically similar; mortality was insignificantly lesser for group TE (12.5% versus 6.6%; = 1.000). Fall in serum procalcitonin was significantly greater for group TE.
Thoracic epidural was associated with insignificant clinical trend towards better organ functions and lesser mortality; along with significantly greater fall in serum procalcitonin. These are encouraging results that could guide future use of thoracic epidural in acute pancreatitis for its non-analgesic benefits.
Tyagi A, Gupta YR Effect of Segmental Thoracic Epidural Block on Pancreatitis Induced Organ Dysfunction: A Preliminary Study. Indian J of Crit Care Med 2019;23(2):89-94.
这项初步随机对照研究评估了胸段硬膜外阻滞（TEB）对急性胰腺炎所致器官功能障碍/衰竭进展的影响。
预计为重症急性胰腺炎且无TEB禁忌证的患者被随机分为接受TEB组（TE组）或不接受TEB组（NTE组）（每组n = 16）。对于TE组，在T8 - 9或T9 - 10椎间隙进行TEB，输注0.2%罗哌卡因并加入2 μg/mL芬太尼；在NTE组，改用静脉注射吗啡，两种干预措施均滴定至数字疼痛评分（NRS）<4。每日评估序贯器官衰竭评估（SOFA）评分，直至从重症监护病房（ICU）出院，将ICU住院期间各器官系统最差评分相加计算的累计SOFA评分作为主要结局指标。记录患者结局的其他替代指标作为次要目标。
两组的累计SOFA评分在统计学上相似（NTE组：3[2 - 4]；TE组：5[2 - 6]）（P = 0.379）；但TE组的SOFA评分有改善趋势，而NTE组则恶化。住院时间和需要机械通气的患者数量在统计学上相似；TE组的死亡率略低，但无统计学意义（12.5%对6.6%；P = 1.000）。TE组血清降钙素原下降幅度明显更大。
胸段硬膜外阻滞与器官功能改善和死亡率降低的不显著临床趋势相关；同时血清降钙素原下降幅度明显更大。这些结果令人鼓舞，可为未来在急性胰腺炎中使用胸段硬膜外阻滞以获得非镇痛益处提供指导。
Tyagi A, Gupta YR 节段性胸段硬膜外阻滞对胰腺炎所致器官功能障碍的影响：一项初步研究。《印度重症医学杂志》2019年；23(2):89 - 94。
