Effect of epidural blockade on indicators of splanchnic perfusion and gut function in critically ill patients with peritonitis: a randomised comparison of epidural bupivacaine with systemic morphine
Effect of epidural blockade on indicators of splanchnic perfusion and gut function in critically ill patients with peritonitis: a randomised comparison of epidural bupivacaine with systemic morphine
复制标题
硬膜外阻滞对危重腹膜炎患者内脏灌注和肠道功能指标的影响：硬膜外布比卡因与全身吗啡的随机比较
DOI：
10.1007/s001340000671
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发表时间：
2000
影响因子：
38.9
通讯作者：
F. Reynolds
中科院分区：
文献类型：
--
作者：
D. Spackman;A. Mcleod;S. Prineas;R. Leach;F. Reynolds
目的：（a）测量腹膜炎危重患者的胃张力值，并评估硬膜外镇痛对这些值的影响。(b)通过腹部超声和扑热息痛吸收评价硬膜外镇痛对胃肠动力的影响。(c)为了观察硬膜外镇痛可能导致的临床结果的任何变化，在这样的patients.Design：一般强化治疗单元（ITU）patients.Patients的双盲，前瞻性，随机和对照研究：21例腹膜炎和粘连性小肠腹部手术后入院的患者被随机分配接受静脉吗啡或硬膜外布比卡因镇痛。在入院时和镇痛24 h后测定胃粘膜内pH值（pHig）和粘膜：动脉PCO 2梯度（Pg-PaCO 2）。对眼压测量值平均变化的分析显示，吗啡组Pg-PaCO 2升高，pHg下降，两组Pg-PaCO 2趋势存在显著差异（p=0.024）。在硬膜外组中观察到小肠超声表现的显著改善（p=0.0037，在当地开发的评分系统中中位数变化的Mann-WhitneyU检验）。两组间对乙酰氨基酚吸收试验（n=10）的任何变量均无显著差异;两组在整个研究期间均显示持续延迟胃流出。结论：硬膜外镇痛可改善胃粘膜灌注和小肠超声表现，表明传统上禁忌硬膜外导管插入的一组患者具有潜在的临床获益
Objectives: (a) To measure gastric tonometry values in critically ill patients with peritonitis and to assess the impact of epidural analgesia on these values. (b) To assess the impact of epidural analgesia on gastro-intestinal motility by abdominal ultrasound and paracetamol absorption. (c) To observe any change in clinical outcome that may result from the use of epidural analgesia in such patients.Design: A double-blinded, prospective, randomised and controlled study of general intensive therapy unit (ITU) patients.Patients: Twenty-one patients admitted with peritonitis and adynamic small bowel following abdominal surgery were randomly allocated to receive either intravenous morphine or epidural bupivacaine for analgesia.Measurementsandresults: Gastric intramucosal pH (pHig) and the mucosal:arterial PCO2gradient (Pg-PaCO2) were measured at admission and after 24 h of analgesia. Analysis of mean changes in tonometry values showed a rise in Pg-PaCO2and a fall in pHigin the morphine group and a significant difference between groups in the Pg-PaCO2trends (p=0.024). Significant improvements in the ultrasound appearance of the small bowel were observed in the epidural group (p=0.0037, Mann-WhitneyUtest of median changes in a locally developed scoring system). There were no significant differences between the groups in any of the variables derived from the paracetamol absorption test (n=10); both groups showed persistently delayed gastric outflow throughout the study period.Conclusions:Epidural analgesia resulted in improvements in gastric mucosal perfusion and the ultrasound appearance of the small bowel, indicating potential clinical benefit in a group of patients in whom epidural catheterisation is traditionally contraindicated