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本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见 Continuous Pulse Oximetry and Capnography Monitoring for Postoperative Respiratory Depression and Adverse Events: A Systematic Review and Meta-analysis. 背景 最近有关的临床数据表明，胸部硬膜外镇痛（一种主要用于减轻疼痛的技术）可以在急性胰腺炎期间发挥抗炎作用，增强内脏及胰腺血流量;然而，硬膜外镇痛对死亡率的影响仍在研究中。因此，本研究旨在评估硬膜外镇痛对ICU急性胰腺炎患者死亡率的影响。 方 法 本研究为多中心、回顾性、观察性、队列研究，观察对象为2009年6月至2014年3月期间法国和比利时的17个ICU中所有患急性胰腺炎的患者，分为胸部硬膜外镇痛与无硬膜外镇痛的标准护理两种方式。主要结果是30天的死亡率。用倾向性分析矫正由于治疗分配不均和预后不平衡所产生的偏倚。 结 果 共3000名急性胰腺炎患者纳入研究，其中212人于30天内死亡。 46例患者使用硬膜外镇痛，与未调整分析的死亡率相比有所降低（4％vs22％; P = 0.003）。在调整了与死亡率相关的基线变量之后，硬膜外镇痛仍然是患者30天内死亡率的独立预测因子（校正比值比=0.10; 95％CI:0.02～0.49; p = 0.004）。使用倾向评分分析，接受硬膜外镇痛的急性胰腺炎患者30天死亡率的风险明显低于未接受硬膜外镇痛的患者（2％vs17％; p = 0.01）。 结 论 在危重症急性胰腺炎患者中，接受硬膜外镇痛的患者在30天时的死亡率低于没有接受硬膜外镇痛的患者。这些研究结果支持正在进行的使用硬膜外镇痛作为干预治疗急性胰腺炎的研究。 原始文献摘要 Objective: Recent preclinical and clinical data suggest that thoracic epidural analgesia, a technique primarily aimed at decreasing pain, might exert anti-inflammatory effects, enhance splanchnic and pancreatic blood flow during acute pancreatitis; however, the influence of epidural analgesia on mortality remains under investigated in this setting. This study was therefore designed to assess the impact of epidural analgesia on mortality in ICU patients with acute pancreatitis. Design: Multicenter retrospective, observational, cohort study. Setting: Seventeen French and Belgian ICUs. Patients: All patients admitted to with acute pancreatitis between June 2009 and March 2014. Interventions: The primary exposure was thoracic epidural analgesia versus standard care without epidural analgesia. The primary outcome was 30-day mortality. Propensity analyses were used to control for bias in treatment assignment and prognostic imbalances. Measurements and Main Results: One thousand three ICU patients with acute pancreatitis were enrolled, of whom 212 died within 30 days. Epidural analgesia was used in 46 patients andwas associated with reduced mortality in unadjusted analyses(4% vs. 22%; p = 0.003). After adjustment for baseline variables associated with mortality, epidural analgesia was still an independent predictor of 30-day mortality (adjusted odds ratio, 0.10;[95% CI, 0.02–0.49]; p = 0.004). Using propensity score analysis,the risk of all-cause 30-day mortality in patients with acute pancreatitis receiving epidural analgesia wassignificantly lower than that in matched patients who did not receive epidural analgesia (2% vs. 17%; p = 0.01). Conclusions: Among critically ill patients with acute pancreatitis, mortality at 30 days was lower in patients who received epidural analgesia than in comparable patients who did not. These findings support ongoing research on the use of epidural analgesia as a therapeutic intervention in acute pancreatitis. 麻醉学文献进展分享 联系我们 |
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