| Japanese |
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| Title | 重症患者管理への提案 -硬膜外麻酔を応用した重症膵炎の管理- |
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| Subtitle | 原著 |
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| Authors | 鈴木重光*, 石井正大*, 小田博* |
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| Organization | *市立岡崎病院救命救急センター |
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| Journal | 循環制御 |
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| Volume | 11 |
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| Number | 1 |
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| Page | 65-71 |
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| Year/Month | 1990/ |
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| Article | 原著 |
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| Publisher | 日本循環制御医学会 |
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| Abstract | 「要旨」市立岡崎病院救命救急センターでは開発以来, ICU管理方針として呼吸管理にはCPAP, 循環管理には必要十分半輸液と血管拡張療法, 代謝の管理にはGIK(glucose insurin K)を基本としている. 特に重症膵炎に対しては, 疼痛対策として硬膜外麻酔, 逸脱酵素対策として蛋白分解酵素阻害薬などの薬物療法と希釈排泄のための十分な輸液, 腹腔洗浄を応用している, 中でも硬膜外麻酔は腹腔のヤケドとも言える自己消化による激痛を求心路で遮断しカテコラミンの異常分泌を抑え痛みの悪循環を断つ. このため, 呼吸の抑制や意識レベルの低下を起こさず臨床症状の劇的な改善を見る. 交感神経の遮断は血管の拡張を促し希釈のために必要な輸液を可能にしてくれる. 腹腔洗浄は下腹部正中からダグラス窩に挿入された腹膜灌流用のカテーテルで生理食塩水を用いて行う. 等張液であるため洗浄と同時に脱水の補正もできる. このICU的全身管理を外科処置を進める前に行うべきである. |
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| Practice | 基礎医学・関連科学 |
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| English |
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| Title | Proposal for Management of Critical Care Management of Severe Pancreatitis Applied of Epidural Anesthesia |
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| Authors | Shigemitsu Suzuki, Masataka Ishii*, Hirosi Oda* |
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| Organization | Department of Critical Care Medicine Okzaki City Hospital, *Anesthesiology and Surgery Okzaki City Hospital |
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| Journal | Circulation Control |
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| Volume | 11 |
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| Number | 1 |
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| Page | 65-71 |
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| Year/Month | 1990/ |
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| Article | Original article |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | In the intensive care ward of the Okazaki City Hospital, our policy towards intensive treatments is as follows：an application of CPAP for respirtory management, administrations of ample and adequate quantity of fluid with some vasodilating drugs for circultory management, and an application of GIK for metabolic management. In cases of severe pancreatitis, Epidural anesthesia is commendably applied for the pain relief, accompnied with the administration of the proteinase-inhibitors and ample quantity of fluid and the application of peritoneal lavage for for dilution and evacuation of the extricated hamful enzymes. Epidural anesthesia has the effects of blocking the afferent route of severe pain coused by "auto-digestion" with may be likened to "abdominal burn", and of suppressing the abnomal secretion of Catechlamines. Consequentry, epidular anesthesia intersepts the pain-induced visious cycle. Thus, clinical symptoms of severe pancreatitis can dramatically be improved without any inhibition of the patient's respiration and consciousness. The block of the sympathetic nerve results in vasodilation and makes easy administration of ample volume of fluid possible to dilute and evacuate the extricated enzymes. Peritoneal lavage is done using normal saline solution through a catheter inserted into the Douglas' pouch. This lavage with isotonic solution can be helpful for correcion of dehaydration, too. These medical intensive treatments should be performed in advance of any surgical interventions. |
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| Practice | Basic medicine |
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