不同镇痛方法结合激光多普勒血流灌注成像仪观察断指血运防治血管危象的临床研究

The effects of different analgesia methods on patients with finger amputation and replantation under monitoring with Periscan perfusion imaging

目的采用不同镇痛方法结合激光多普勒血流灌注成像（Periscan PIMⅡ）系统动态观察断指再植术后再植指血流状态,防治血管危象以提高再植指成活率及临床疗效。方法本临床研究收集2013年1月~2014年7月住院的345例,根据美国麻醉师协会（American society of anesthesiologists,ASA）对患者体质和手术危险性分级在Ⅰ、Ⅱ级的急诊单指及多指离断伤后行断指再植手术患者,分为口服镇痛组、肌注镇痛组及连续臂丛阻滞镇痛组,每组各115例。比较三组患者再植术后不同镇痛方法对其心理状况的影响,并采用Periscan PIMⅡ观察断指血流状态,计算再植指血管栓塞率、血管危象发生率、再植指成活率及术后6个月再植指功能评分,以评价不同镇痛方法对断指再植术成活率及功能康复的影响。结果连续臂丛阻滞镇痛组正常心理状况占65.22%,再植指血管栓塞率及血管危象发生率明显降低,成活率达93.04%,术后6个月再植指功能评分优良率亦明显增高,与口服镇痛组及肌注镇痛组比较,差异均有统计学意义（P〈0.05）。结论 Periscan PIMⅡ可提供清晰的断指再植术后血管血运状态图像,为预防和处理血管危象提供可靠图像信息,结合连续臂丛阻滞术,在稳定患者不良心理状况、降低断指再植术后血管危象发生、提高再植指成活率及促进再植指功能康复等方面具有明显优势。

Objective This study aimed to investigate effects of different analgesia methods on patients with finger amputation and replantation using Periscan perfusion imaging（ Periscan PIMⅡ）,which can monitor dynamic blood flow in order to improve the survival rate. Methods Totally 345 patients undergoing single finger and multiple finger amputation and replantation surgery were collected during Jan. 2013 to Jul. 2014 in Taihe Hospital and were graded Ⅰ and Ⅱ according to the criteria of the American Society of Anesthesiologists. These patients were divided into oral analgesic group（ ORG）,intramuscular analgesic group（ IAG）,and continuous brachial plexus block analgesia group（ CAG）. Patients＇ psychological status after operation was evaluated. The blood flows of replanted fingers were examined and recorded using Periscan PIMⅡ. The vascular embolization rate,the incidence of vascular crisis,the finger survival rate,and the replantation function score at postoperative 6 months were examined to evaluate the effects of different analgesia methods on finger survival rate and function rehabilitation for digital replantation. Results The rate of normal psychological status in the CAG group was 65. 22%. The rates of replantation finger vascular thrombosis and the incidence of vascular crisis were lower and the finger survival rate was93. 04% in the CAG group. The replantation finger functional score at postoperative 6 months was higher in the CAG group,which was significantly better than those in the ORG and IAG groups（ P 0. 05）. Conclusion The continuous brachial plexus block analgesia method is a better approach to reduce poor psychological status and occurrence of vascular crisis after replantation of amputated finger,to improve replantation finger survival rate and to promote the replanted finger function rehabilitation. Periscan PIMⅡ can provide reliable image information for prevention and treatment of vascular crisis.