| Objective: To observe the effects of thoracic epidural analgesia(TEA)on intra-abdominal pressure,renal function,incidence of AKI,probability of CRRT and renal perfusion in patients with severe acute pancreatitis(SAP),and to evaluate whether TEA has protective effect and possible mechanism on acute renal injury(AKI)secondary to SAP.Methods:In the experimental group,28 patients diagnosed with SAP between2019 and 2020 were included,who received TEA treatment in the early stage in addition to the unified comprehensive treatment plan.Twenty-eight patients with SAP who were only given comprehensive treatment plan but did not receive TEA treatment in the same ward from 2018 to 2019 were used as the control group.Basic data,such as gender,age,etiology of SAP,SAP severity at admission(Ranson score),onset time at admission,TEA and CEUS time after admission,were collected and compared between the two groups.Body temperature(T),heart rate(HR),respiratory rate(R),intra-abdominal pressure(IAP),serum creatinine(Scr),cystatin C(Cys-C),urea(Urea),uric acid(UA),incidence of AKI and probability of CRRT were collected 7 days after ICU in experimental group and control group to evaluate the effect of TEA on secondary AKI in SAP.The dynamic imaging of renal perfusion in the experimental group before and after TEA treatment was obtained by contrast-enhanced ultrasound(CEUS).Using ultrasound image analysis software,the time-intensity curve,time to peak intensity(Tto P),baseline intensity(BI),peak intensity(PI)and other parameters were obtained,and the changes of renal perfusion in patients with SAP before and after TEA were compared and analyzed.This study was approved and supported by the Ethics Committee of the affiliated Hospital of Zunyi Medical University.Results:1.The age of the TEA group was 42.5(34.5,50)years old,and that of the non-TEA group was 43.5(35.5,51)years old,with no statistical difference between the two groups(P=0.35).There were 20 males and 8 females in TEA group.There were 19 males and 9 females in the non-TEA group,and there was no difference in the sex composition ratio between the two groups(P>0.05).The etiology of SAP in TEA group included 14 cases of hyperlipidemia,8 cases of gallbladder,2 cases of alcohol,2 cases of pregnancy and 2 cases of trauma.In the non-TEA group,there were 13 cases of hyperlipidemia,12 cases of gallbladder,1 case of alcohol,1 case of pregnancy and 1 case of trauma,and there was no statistical difference in etiology between the two groups(P>0.05).There was no statistical difference in Ranson scores between the two groups at admission [TEA group: 4(4,5)VS4(3,5),P>0.05].2.There were no significant differences in body temperature(T),respiration(R),heart rate(HR)and intra-abdominal pressure(IAP)between 2 groups on admission(P>0.05).Continuous dynamic monitoring showed that there was no significant difference in body temperature between the two groups(P>0.05).On the 3rd and4 th day after admission,the respiratory rate of TEA group was lower than that of non-TEA group(P<0.05).Heart rate in the TEA group was lower than that in the non-TEA group on the 3rd and 4th day after admission(P<0.05).In contrast,intra-abdominal pressure in the TEA group was significantly lower than that in the non-TEA group from day 2 to day 7(P<0.05).3.There was no significant difference in Scr,Cys-C,urea,UA between TEA group and non-TEA group on admission(P>0.05).The Scr value of TEA group was lower than that of non-TEA group on the 6th day(P<0.05);Similarly,UA level was lower than that of non-TEA group(P<0.05).The levels of urea and Cys-C on the 5th,6th and 7th day after admission were significantly lower than those in the no-TEA group(P<0.05).4.AKI occurred in 8 patients in TEA group,and the incidence of AKI was28.6% However,AKI occurred in 14 patients in non-TEA group,the incidence rate was 50.0%,and there was a statistical difference between the two groups(P<0.05).The number of cases treated with CRRT in TEA group was significantly less [8/28(28.6%)vs 18/28(64.3%)],and the difference between the two groups was statistically significant(P<0.05).5.According to CEUS dynamically developed images,the time intensity curve is analyzed by the image analysis software of ultrasound,and the parameters such as time to peak(Tto P),Base intensity(BI)and Peak intensity(PI)are collected.Results Tto P value after TEA was significantly shorter than that before TEA(7.6 ± 2.2s vs 11.7 ± 2.6s,P<0.05).There is no significant change in BI and PI values before and after TEA(-56.7 ± 3.7d B vs-56.2 ± 7.8d B;26.8 ± 7.6 d B vs24.4 ±7.2d B,P>0.05).Conclusion:In early SAP patients,TEA may improve renal function indexes such as creatinine,urea,uric acid and cystatin C,and reduce the occurrence of AKI and the probability of CRRT.TEA can significantly reduce intra-abdominal pressure and improve renal perfusion in patients with SAP,which may be an important mechanism for the renal protective effect of TEA on patients with SAP. |
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