Effects of thoracic epidural anesthesia on survival and microcirculation in severe acute pancreatitis: a randomized experimental trial
Effects of thoracic epidural anesthesia on survival and microcirculation in severe acute pancreatitis: a randomized experimental trial
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DOI：
10.1186/cc13142
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发表时间：
2013-01-01
期刊：
影响因子：
15.1
通讯作者：
Mann, Oliver
中科院分区：
文献类型：
--
作者：
Bachmann, Kai A.;Trepte, Constantin J. C.;Mann, Oliver
简介：重症急性胰腺炎仍然是一种潜在威胁生命的疾病，死亡率很高。本研究的目的是在前瞻性动物研究中评估胸段硬膜外麻醉 (TEA) 对重症急性胰腺炎实验动物模型的生存、微循环、组织氧合和组织病理学损伤的治疗效果。 方法：在本研究中，34 头猪被随机分为 2 个治疗组。第1组（n=17）导管内注射甘去氧胆酸诱导重症急性胰腺炎后，经TEA给予布比卡因（0.5%；推注2ml，持续输注4ml/h）。第 2 组 (n = 17) 未使用 TEA。诱导后 6 小时内，评估胰腺中的组织氧张力 (tpO(2)) 和胰腺微循环。此后观察动物7天，然后处死并进行组织病理学检查。结果：第1组（TEA）7天后的存活率为82％，而第2组（对照）为29％（P <0.05）。与第 2 组（对照组）相比，第 1 组 (TEA) 还表现出显着优越的微循环（1,608 +/- 374 AU 对比 1,121 +/- 510 AU；P < 0.05）和组织氧合（215 +/- 64 mmHg 对比 138 +/- 90 mmHG；P < 0.05）。随后，第 1 组的组织病理学评分减少（5.5（3 至 8）与 8（5.5 至 10）；P < 0.05）。结论：TEA 可以改善重症急性胰腺炎实验动物模型的生存率，增强微循环灌注和组织氧合，并减少组织病理学组织损伤。
Introduction: Severe acute pancreatitis is still a potentially life threatening disease with high mortality. The aim of this study was to evaluate the therapeutic effect of thoracic epidural anaesthesia (TEA) on survival, microcirculation, tissue oxygenation and histopathologic damage in an experimental animal model of severe acute pancreatitis in a prospective animal study.Methods: In this study, 34 pigs were randomly assigned into 2 treatment groups. After severe acute pancreatitis was induced by intraductal injection of glycodesoxycholic acid in Group 1 (n = 17) bupivacaine (0.5%; bolus injection 2 ml, continuous infusion 4 ml/h) was applied via TEA. In Group 2 (n = 17) no TEA was applied. During a period of 6 hours after induction, tissue oxygen tension (tpO(2)) in the pancreas and pancreatic microcirculation was assessed. Thereafter animals were observed for 7 days followed by sacrification and histopathologic examination.Results: Survival rate after 7 days was 82% in Group 1 (TEA) versus 29% in Group 2: (Control) (P < 0.05). Group 1 (TEA) also showed a significantly superior microcirculation (1,608 +/- 374 AU versus 1,121 +/- 510 AU; P < 0.05) and tissue oxygenation (215 +/- 64 mmHg versus 138 +/- 90 mmHG; P < 0.05) as compared to Group 2 (Control). Consecutively, tissue damage in Group 1 was reduced in the histopathologic scoring (5.5 (3 to 8) versus 8 (5.5 to 10); P < 0.05).Conclusions: TEA led to improved survival, enhanced microcirculatory perfusion and tissue oxygenation and resulted in less histopathologic tissue-damage in an experimental animal model of severe acute pancreatitis.