平板数字减影血管造影观察断指再植术后不同镇痛方法对再植指成活的影响

Research on the Influence of Three Postoperative Analgesia Methods on the Survival Rate of Replanted Finger by Flat Digital Subtraction Angiography

目的应用平板数字减影血管造影(DSA)医学成像探测系统动态观察断指再植术后不同镇痛方法对再植指术后血管危象的发生及成活的影响。方法 2014年7月-2015年7月将342例身体状况分级为Ⅰ、Ⅱ级的断指再植术患者按入院先后顺序分为常规口服组、肌肉注射组及自控镇痛组,每组各114例。应用平板DSA动态观察断指再植术后血运,比较不同镇痛方法对患者心理状况、血管危象的发生率、栓塞率、成活率的影响。术后6个月对患者再植指功能进行评分以评价临床疗效。结果与常规口服组及肌肉注射组比较,自控镇痛组再植指血管危象发生率及栓塞率明显降低,再植成活率为96.69%,心理状况正常的患者达78.07%,差异均有统计学意义(P<0.017);6个月回访优良率明显高于常规口服组及肌肉注射组(P<0.017)。结论平板DSA的3D技术提供的断指再植术后血管血运状态图像清晰可靠,使用连续臂丛阻滞术进行自控镇痛的镇痛效果明显优于其他镇痛方法,良好的镇痛可稳定患者焦躁不良情绪,避免血压过大波动诱发微小动脉痉挛造成血管栓塞和血管危象,进而提高成活率并促进再植指功能及早康复。

Objective To observe the influence of three postoperative analgesia methods on the survival rate of replanted finger by flat digital subtraction angiography（DSA） medical imaging detection system. Methods From July 2014 to July 2015, 342 patients were classified into grade Ⅰ and grade Ⅱ replantation in accordance with their physical condition and they were randomly divided into routine oral group, muscle injection group and analgesia group with 144 patients in each. Flat DSA was used to dynamically observe replantation after revascularization. Then we compared the three different analgesia methods in terms of psychological status of the patients, incidence of vascular crisis, occlusion rate, survival rate of replanted fingers. The function score of replanted fingers was evaluated for clinical efficacy. Results Compared with the conventional oral group and muscle injection group, the incidence of vascular crisis in replanted fingers and thrombosis rate were significantly lower in the analgesia group which had a replanted finger survival rate of 96.69% and a normal mental condition rate of 78.07%. Six months after surgery, the rate of excellent and good follow-up was significantly higher than the conventional oral group and muscle injection group（P 0.017）. Conclusion The 3-D technology of flat DSA can provide clear and reliable pictures of vessel revascularization status for replanted fingers. The use of continuous brachial plexus analgesia performs better than other methods of analgesia. Good analgesia can stabilize patients＇ anxiety and negative emotions, which is helpful to avoid excessive fluctuations in blood pressure induced by small artery spasm caused by blood clots and vascular crisis, thereby increasing the survival rate ofreplanted fingers and facilitating early rehabilitation of their function.