连续臂丛阻滞术后自控镇痛对断指、断腕再植患者患肢氧代谢的影响

Influence of patient-controlled brachial plexus analgesia on oxygen metabolism in replantation of amputated finger patients

目的观察断指再植术后患者自控肌间沟镇痛(PCBA)对乳酸(LA)及患肢血氧饱和度的影响,间接反映PCBA对断指再植术后血供的影响。方法三指以上完全离断或断腕的再植术患者30例,随机分为镇痛组(A组)和对照组(B组),每组15例。采用肌间沟法臂丛神经阻滞并留置套管针。手术结束后,A组患者行术后PCBA。镇痛剂:0.25%罗哌卡因+0.5mg芬太尼稀释至100mL,速率:2mL/h。B组患者术后按需肌注盐酸哌替啶48h。观察两组LA、血氧饱和度(SpO2)变化。结果两组术后各时点乳酸浓度均升高(P<0.05),且B组术后各时点乳酸浓度均较A组升高(P<0.05)。A组所有患者术后再植指指腹红润,平均SpO297%;B组有10指颜色苍白,平均SpO291%。两组比较,P<0.05。A组毛细血管充盈时间短于B组[(1.25±0.13)svs.(3.67±0.22)s,P<0.05)。结论PCBA可减轻无氧代谢,降低LA水平,改善断指再植指血液循环,有利于再植物的成活。

Objective To investigate the effects of patient-controlled brachial plexus analgesia on oxygen metabolism in replantation of amputated finger patients. Methods 30 patients with 3 or more fingers mutilation were randomly divided into 2 groups with 15 patients in each group：analgesia group（A） and control group （B）. All patients undertook brachial plexus block anesthesia with indwelling canula. In group A, an analgesic pump（ 2 mL/h）was fixed as operation achievement ,.the content of pump consisting of 100 mL physiologic saline ＋ 0. 75% ropivacaine 30 mL ＋ 0. 5 mg fentanyl. In group B, Sauteralgyl was injected intramuscularly for 48 h after operation. The lactic acid （LA） , saturation of blood oxygen（ SpO2 ） were observed. Results Concentration of LA in blood increased in both group. But the increase was more apparent in group B（P 〈0. 05）. The mean value of SpO2 in 2 groups had obvious differences[97% （A） 〉 91% （ B ） ]. Capillary filling time of 2 groups were （ 1.25 ±0. 13 ） s （A） , （ 3.67 ±0. 22 ） s （ B ） respectively （ P 〈 0.05 ）. Conclusion PCBA can release anaerobic metabolism, decrease concentration of LA, improve microcirculation of amputated fingers, and it profits the take in amputated fingers.