Kariya N, Oda Y, Yukioka H, Fujimori M
Department of Anesthesiology and Intensive Care Medicine, Osaka City University Medical School, Osaka.
Masui. 1996 Feb;45(2):223-6.
A 46-year-old man involved in a traffic accident was admitted to our university hospital for treatment of acute subdural hematoma of the brain, multiple rib fractures and hemothorax. On admission, he manifested disturbance of consciousness, and his left upper and lower extremities were paralyzed. Blood gas analysis revealed hypoxia, and he was nasotracheally intubated. He was mechanically ventilated with 10 cmH2O positive end-expiratory pressure for treatment of rib fractures following surgical removal of the subdural hematoma and insertion of a sensor into the epidural space for measurement of intracranial pressure. Despite continuous intravenous infusion of midazolam and buprenorphine, he was agitated and thrashed from side to side, probably due to severe chest pain caused by rib fractures. Agitation was effectively controlled by continuous thoracic epidural administration of morphine and bupivacaine. Intracranial pressure did not increase, and epidural analgesia was without sequelae. The patient's level of consciousness gradually improved, rib fractures were treated and he was extubated on the 25th hospital day. These findings indicate that epidural analgesia is useful for controlling pain-related agitation caused by head and chest injuries if increased intracranial pressure is not present.
一名46岁男性因交通事故被送至我校医院，治疗急性脑硬膜下血肿、多根肋骨骨折和血胸。入院时，他意识障碍，左上肢和下肢瘫痪。血气分析显示缺氧，遂行鼻气管插管。在硬膜下血肿手术清除及硬膜外置入传感器测量颅内压后，为治疗肋骨骨折，给予其10 cmH2O呼气末正压机械通气。尽管持续静脉输注咪达唑仑和丁丙诺啡，但他仍烦躁不安、辗转反侧，可能是由于肋骨骨折导致的剧烈胸痛。通过持续硬膜外给予吗啡和布比卡因，有效控制了躁动。颅内压未升高，硬膜外镇痛无后遗症。患者意识水平逐渐改善，肋骨骨折得到治疗，于住院第25天拔管。这些结果表明，如果不存在颅内压升高，硬膜外镇痛对于控制头部和胸部损伤引起的与疼痛相关的躁动是有用的。
