不同药物持续臂丛阻滞术后镇痛对断指再植病人内分泌的影响

The effect of continuous brachial plexus block for postoperative analgesia on en docrine in patients after replantation of amputated fingers

目的 探讨连续臂丛阻滞不同药物术后镇痛对断指再植病人内分泌的影响。方法 84例断指再植病人 ,按术后用药不同随机分为对照组、吗啡组、芬太尼组和曲马多组 ,对比术后镇痛效果并测定麻醉前、术后 4、12、2 4、4 8小时血糖、皮质醇、血管紧张素Ⅱ和肾上腺素的血浆浓度。结果 镇痛组组间内分泌激素水平相比无明显差异 ,但与对照组相比显著降低。组内与麻醉前相比显著降低。呼吸功能各组无显著性差异。镇痛 3组VAS评分均较低 ,与麻醉前和对照组相比差异显著 ,吗啡组和芬太尼组病人镇痛效果较佳 ,但吗啡组病人恶心、呕吐和皮肤搔痒等不良反应明显。结论 连续臂丛阻滞术后镇痛能有效地抑制断指再植病人的应激反应 ,低浓度布比卡因与芬太尼混合液镇痛效果确切 ,不良反应少而更适用于此类病人。

Objective To investigate the effects of c on tinuous brachial plexus block with different drugs for postoperative analgesia o n endocrine in patients after replantation of amputated fingers.Metho ds Eighty-four patients undergoing emergency replantation of amputat ed fingers, ASA gradeⅠ-Ⅱ, were randomly assigned into four groups with 21 case s each: control group(C), morphine group(M), fentanyl group(F) and tramadol grou p(T). After operation pethidine was given intermittently in group C and continuo us brachial plexus block was applied in other three groups. Postoperative analge sia was assessed, BP, HR, ECG, SpO 2 and P ETCO 2 were monitored and reco rded during and after operation. The levels of blood glucose (GLU), cortisol(Col ), angiotensinⅡ(AⅡ) and epinephrine(E) were observed at five time points: befo re anesthe sia, at 4, 12, 24, 48h postoperative.Results The age, sex , weight and ASA status were comparable among the four groups, The VAS score was significantly lower in three analgesia groups than that in group C, but the dif ference was not significant among the three analgesia groups. The blood glucose ,cortisol, AⅡ, E levels were comparable among the four groups before anesthesi a, but were significantly lower in analgesia groups during the postoperative per iod than those in group C. There was no significant difference in cortisol, AⅡ and E among the three analgesia groups (P>0.05).Conclusion Continuous brachial plexus block for postoperative analgesia can effectiv ely inhibit the stress response in patient after the replantation of amputated f ingers. Fluid of fentanyl and bupivacaine provide the best analgesia with less a dverse effects and is suitable for postoperative analgesia in these patients.