连续臂丛阻滞麻醉及术后自控镇痛对断指再植成活率的影响

Effect of continuous brachial plexus block and PCA for survival degree of digit replantation

目的观察连续臂丛阻滞术后自控镇痛对断指再植成活率的影响。方法选择急诊手术ASA Ⅰ、Ⅱ级单指离断伤行断指再植术病人45例,随机分成A、B两组。A组行连续臂丛阻滞,术后连接PCA泵行自控镇痛,镇痛配方为芬太尼0.3mg+0.15%罗哌卡因共100mL,第3天拔除导管;B组行单次臂丛阻滞,术后按需肌注曲马多100mg。观察两组的镇痛效果评分、再植指的血运情况、血管栓塞率及再植指成活率。结果A组镇痛效果均为优或良,未发生血管危象,成活率为100%。B组镇痛效果为优或良12例占54.5%,发生血管痉挛7例占31.8%,4例再植失败,成活率为81.8%。结论连续臂丛阻滞术后自控镇痛镇痛效果确切,安全性高,可减少断指再植术后血管危象的发生率,明显提高再植指成活率。

[Objective] To study the effect of continuous brachial plexus block for PCA in the survival degree of digit replantation. [Methods] Forty-five emergency one-digit replantation patients （ASA Ⅰ-Ⅱ ） were randomly divided into group A and group B. Patients in group A recevived a continuous brachial plexus block and a perineural catheter. After the operation, all patients recevived continuous postoperation analgesia with a PCA pump delivering analgetic solution （Fentanyl 0.3 mg ＋ 0.15% Ropivacaine） for 48 hours. Group B was control group, patients received a brachial plexus block and Tramadol 100 mg if they needed after the operation. Observed and recorded the visual analogue scale （VAS） scores, circulation and the survival degree of the replanted digit. [Results] All the VAS scores in group A were lower and the satisfaction scores were higher. The circulation complications had low incidence and the survival degree of digit replantation was 100%, Group B had a 54.5% analgesic satisfaction scores, seven patients had a circulative complications and four patients failed. The survival degree was 81.8%. [Conclusion] Continuous brachial plexus block for patient-controlled analgecia in digit replantation is effectual and safe. It can lower the circulative complications and improve the survival degree of digit replantation.