超声引导臂丛神经穿刺置管在断指再植术后镇痛中的应用

UItrasound-guided brachial plexus catheterization finger replantation for postoperative analggsia

目的探讨超声引导臂丛神经穿刺置管在断指再植术后镇痛的指导价值。方法80例急诊拟行一指或两指断指再植手术的患者（男58例，女22例），年龄17～67岁，ASAI～III级，无颈部外伤及臂丛神经损伤，按术后镇痛方式随机分为连续臂丛神经阻滞（PCBA组）和静脉镇痛组（PCIA组）。采用视觉模糊评分（VAS）对两组患者术后24h和48h的镇静、镇痛程度进行评价，并记录出现恶心、呕吐、膈神经阻滞等并发症的例数。结果所有患者均能舒适地接受超声引导臂丛神经穿刺过程，术中麻醉效果确切。PCBA组超声引导臂丛穿刺置管过程顺利，全部成功。PCBA组与PCIA组比较，VAS评分和镇静程度差异有显著统计学意义（P〈0．叭），PCIA组的血管痉挛及恶心、呕吐发生率高于PCBA组。结论应用超声引导臂丛神经穿刺置管具有神经定位准确，成功率高；且PCBA组更好地改善了再植指的血运供应，提高了再植指的成活率，避免了加用阿片类药物引起的恶心、呕吐等并发症，增加了患者的舒适度。

Objective To study the ultrasound-guided braehial plexus catheterization finger replantation in the guidance of the value of postoperative analgesia. Methods 80 eases of emergency means to be a line or two referring to digital replantation patients （ male 58 cases,22 cases of women）, aged 17 - 67-year-old, ASA Ⅰ-Ⅲclass, non-traumatic neck and brachial plexus injury, by means of postoperative analgesia were randomly divided into continuous brachial plexus block（ PCBA group）and intravenous analgesia group（ PCIA group）. Visual analog scale （VAS） were patients of the 24 h and 48 h after the sedative and analgesic evaluation of the extent of, and record the emergence of nausea, vomiting, complications such as phrenic nerve block several of the cases. Results All patients were able to comfortably accept the ultrasound-guided brachial plexus puncture process,the exact effect of intraoperative anesthesia, that of PCBA Group of ultrasound-guided brachial plexus puncture the smooth process, all successfully. PCBA group compared with the PCIA group, VAS score and sedation extent there was a significant difference （ P 〈 0. 01 ）, PCIA vasospasm group and incidence of nausea and vomiting was higher than PCBA Group. Conclusion Ultrasound-guided brachial plexus nerve catheterization with positioning accuracy, the success rate is high ; and PCBA group replantation better means to improve the blood supply,improve the survival rate of replanted digits to avoid the added opioid-induced nausea, vomiting and other complications, increase patient comfort.