Jomura K, Hamada T, Sugiki K, Ito Y
Department of Anesthesiology, Toyama Medical and Pharmaceutical University.
Masui. 1997 Dec;46(12):1602-8.
Stress response and increased sympathetic stimulation constrict gastrointestinal blood vessels. In patients after abdominal surgery, anastomotic leakage and bacterial translocation may occur as a result of gastrointestinal hypoperfusion. These patients are at risk for severe SIRS and MOF, especially after emergency surgery. Epidural anesthesia decreases sympathetic stimulation and accordingly increases gastrointestinal blood flow. The purpose of this study was to test the hypothesis that epidural anesthesia has a beneficial effect on patients after emergency abdominal surgery. Seventy-seven patients older than 50 years of age having undergone emergency abdominal surgery were studied. Thirty-nine patients received general anesthesia alone (GA) and 38 patients received epidural anesthesia (EA). The data on APACHE II score, fluid intake and output management, mortality rate, and others of the subjects were collected from patient charts. The mortality rate 3 months after surgery in group GA (35.9%) was significantly higher than that in group EA (5.3%) (P < 0.01). There was no difference in APACHE II score and age. Fluid intake was significantly larger in group EA. To reduce mortality rate, epidural anesthesia and volume expansion are recommended for patients after emergency abdominal surgery.
应激反应和交感神经刺激增强会使胃肠道血管收缩。腹部手术后的患者，可能因胃肠道灌注不足而发生吻合口漏和细菌移位。这些患者有发生严重全身炎症反应综合征（SIRS）和多器官功能衰竭（MOF）的风险，尤其是在急诊手术后。硬膜外麻醉可降低交感神经刺激，从而增加胃肠道血流量。本研究的目的是验证硬膜外麻醉对急诊腹部手术后患者有有益作用这一假设。对77例年龄超过50岁的急诊腹部手术患者进行了研究。39例患者仅接受全身麻醉（GA），38例患者接受硬膜外麻醉（EA）。从患者病历中收集受试者的急性生理与慢性健康状况评分系统（APACHE II）评分、液体出入量管理、死亡率等数据。GA组术后3个月的死亡率（35.9%）显著高于EA组（5.3%）（P<0.01）。APACHE II评分和年龄无差异。EA组的液体摄入量显著更大。对于急诊腹部手术后的患者，建议采用硬膜外麻醉和容量扩充以降低死亡率。
