Dittmann M, Keller R, Wolff G
Intensive Care Med. 1978 Nov;4(4):193-7. doi: 10.1007/BF01902546.
Thoracic epidural analgesia (EA) is described as an alternative to controlled ventilation in patients presenting with multiple rib fractures. Lung mechanics were especially studied in 6 patients selected from a total of 49. The average ICU stay for this group was 4.5 days (2-11) and the mean age 55.7 years. The EA group was compared with 51 patients primarily ventilated who had an average stay in the ICU of 9.8 days and a mean age of 44.7 years. Mean number of rib fractures of the ventilated group at 6.5 was almost equal to the mean of 6.8 in the EA group. There was a difference in the number of associated fractures, 98 in the ventilated group compared to 35 in the EA group. Severe pulmonary and cerebral contusion were the two most important factors in enforcing the need to ventilate. The success of the method is evidenced by the increase in functional residual capacity (FRC), dynamic lung compliance (Cdyn), vital capacity (VC), the decrease of airway resistance (R) and a significantly increase of PaO2 (p less than 0,001) for the EA group with a balanced fluid therapy. All this accounts for the clinical observation of diminishing paradoxical movement of the flail segment.
胸段硬膜外镇痛（EA）被描述为多根肋骨骨折患者控制通气的一种替代方法。在从49例患者中选出的6例患者中对肺力学进行了专门研究。该组患者在重症监护病房（ICU）的平均住院时间为4.5天（2 - 11天），平均年龄为55.7岁。将EA组与51例主要接受机械通气的患者进行比较，这些患者在ICU的平均住院时间为9.8天，平均年龄为44.7岁。机械通气组肋骨骨折的平均数量为6.5根，几乎与EA组的6.8根平均数量相等。两组患者合并骨折的数量存在差异，机械通气组为98处，而EA组为35处。严重肺挫伤和脑挫伤是需要进行机械通气的两个最重要因素。对于接受平衡液体治疗的EA组，功能残气量（FRC）增加、动态肺顺应性（Cdyn）增加、肺活量（VC）增加、气道阻力（R）降低以及动脉血氧分压（PaO2）显著升高（p < 0.001），证明了该方法的成功。所有这些都解释了连枷胸段反常运动减轻的临床观察结果。
