Iwama H, Kawamae K, Katsumi A, Okada K, Tase C, Akama Y
Critical Care and Trauma Center, General Aizu Central Hospital, Aizuwakamatsu.
Masui. 1993 May;42(5):669-76.
Twelve chest trauma patients with severe pain were studied. All of them had multiple rib fractures, hemopneumothorax or pulmonary contusion, and needed the continuous chest drainage. 16 G epidural block catheter was introduced 20 cm into the apex of the pleural space. Furthermore, another catheter was placed into the base of the pleural space. After injecting 1% lidocaine 10 ml, the analgesic effect, the analgesic range according to injected point (apex or base), and the changes of vital signs, PaO2/FIO2 and PaCO2 were evaluated. The average pain scale before interpleural regional analgesia (IPA) was 2.9 and 1.0 after 15 min. The time to return to pre-IPA condition took about 150 min. The mean blood pressure did not show significant changes, although pulse and respiratory rate decreased. PaCO2 did not show significant changes, although PaO2/FIO2 increased significantly. The present study indicates that IPA in chest trauma reduces pain and improves PaO2/FIO2 significantly without circulatory changes. It was reported that it was difficult to obtain effective pain relief after thoracotomy. However, when the catheter is placed at the apex, it seems to be effective to relief pain on the chest site. In conclusion, IPA seems to be simple, effective and useful to remove pain from chest trauma when epidural block is difficult to induce.
对12例胸部创伤伴严重疼痛的患者进行了研究。他们均有多根肋骨骨折、血气胸或肺挫伤，且均需要持续胸腔闭式引流。将16G硬膜外阻滞导管置入胸膜腔顶部20cm处。此外，在胸膜腔底部再置入一根导管。注入1%利多卡因10ml后，评估镇痛效果、根据注射部位（顶部或底部）的镇痛范围以及生命体征、动脉血氧分压/吸入氧分数（PaO2/FIO2）和动脉血二氧化碳分压（PaCO2）的变化。胸膜间区域镇痛（IPA）前的平均疼痛评分是2.9，15分钟后为1.0。恢复到IPA前状态的时间约为150分钟。尽管脉搏和呼吸频率下降，但平均血压未显示出显著变化。尽管PaO2/FIO2显著升高，但PaCO2未显示出显著变化。本研究表明，胸部创伤患者行IPA可显著减轻疼痛并改善PaO2/FIO2，且无循环系统改变。据报道，开胸术后难以获得有效的疼痛缓解。然而，当导管置于顶部时，似乎对缓解胸部疼痛部位的疼痛有效。总之，当硬膜外阻滞难以实施时，IPA对于消除胸部创伤疼痛似乎简单、有效且实用。
