胸段硬膜外麻醉的非镇痛作用

胸段硬膜外麻醉(thoracic epidural anesthesia,TEA)被广泛用于心脏、胸部和腹部的手术及术后镇痛.然而,许多基础及临床研究都证实TEA除了减轻疼痛,还有更广泛的其他作用.TEA可以降低神经内分泌应激反应,对免疫和凝血系统也有积极的作用,减少围手术期并发症.此外,TEA导致的胸交感神经阻滞被建议用于围术期心、肺、胃肠道的保护.因此这项技术对于很多外科手术的预后有着重要的影响.此文针对TEA非镇痛方面的作用及新近关于TEA应用于重大手术的研究作一综述.

Non-analgetic effects of thoracic epidural anaesthesia

Thoracic epidural anaesthesia (TEA) are practised extensively for cardiac, thoracic and abdominal surgery.However, many experimental and clinical studies have shown that TEA may have effects far beyond pain relief. TEA may decrease the neuroendocrine stress response and reduce the number of perioperative complications. Furthermore, transient thoracic sympathectomy by TEA has been suggested to offer protective cardiac, pulmonary and gastrointestinal effects as well as positive immunological and coagulation properties. The technique is thus thought to have a significant impact on the outcome of major surgical procedures. This review will focus on these non-anaigetic aspects of TEA, and will discuss the most important works published recently regarding outcome studies in patients undergoing major surgery and epidural anaesthesia.