Nair Abhijit, Tiwary Manish Kumar, Seelam Suresh, Kotthapalli Krishna Kishore, Pulipaka Kaushik
Anesthesiology, Ibra Hospital, Ibra, OMN.
Anesthesiology, Royal Hospital, Muscat, OMN.
Cureus. 2022 Mar 16;14(3):e23234. doi: 10.7759/cureus.23234. eCollection 2022 Mar.
Patients admitted to the intensive care unit with moderate to severe acute pancreatitis carry significant morbidity and mortality. A few unfortunate patients in whom the initial line of treatment fails to show clinical improvement develop multiorgan dysfunction involving lungs (adult respiratory distress syndrome), renal failure, intra-abdominal infections, sepsis, and septic shock, which ultimately leads to prolonged hospitalization and a substantial cost of treatment. The acute abdominal pain experienced by these patients is excruciating and requires multimodal analgesia. Continuous epidural analgesia has been found to provide good quality, opioid-sparing analgesia in these patients. A few studies have also demonstrated that segmental sympathectomy resulting from epidural blockade could lead to lowering of serum amylase and lipase levels improve paralytic ileus, and thus hastens the process of recovery. The present paper aims to discuss the advantages of continuous epidural analgesia in patients with acute pancreatitis of varying severity and to review the existing literature using specific keywords.
入住重症监护病房的中重度急性胰腺炎患者具有较高的发病率和死亡率。一些不幸的患者，其初始治疗方案未能显示出临床改善，进而发展为多器官功能障碍，包括肺部（成人呼吸窘迫综合征）、肾衰竭、腹腔内感染、败血症和感染性休克，这最终导致住院时间延长和治疗费用大幅增加。这些患者所经历的急性腹痛极为剧烈，需要多模式镇痛。已发现持续硬膜外镇痛可为这些患者提供高质量的、节省阿片类药物的镇痛效果。一些研究还表明，硬膜外阻滞导致的节段性交感神经切除术可降低血清淀粉酶和脂肪酶水平，改善麻痹性肠梗阻，从而加速康复进程。本文旨在探讨不同严重程度急性胰腺炎患者持续硬膜外镇痛的优势，并使用特定关键词对现有文献进行综述。
