超声引导下连续臂丛神经阻滞对肱动脉-贵要静脉人工血管移植内瘘血流的影响

The influence of ultrasound-guided continuous brachial plexus block on the blood flow in brachial artery-basilic vein arteriovenous graft

目的观察超声引导下连续臂丛神经阻滞对肱动脉-贵要静脉人工血管内瘘血流的影响。方法选择拟行上臂肱动脉-贵要静脉人工血管内瘘成形术患者共78例，采用随机数字表法分为单次臂丛神经阻滞组（SBB组）和连续臂丛神经阻滞组（CBB组），每组39例，操作均在超声引导下进行，CBB组术后接神经阻滞镇痛泵自控镇痛（PCNA），比较两组术前（T0）动脉直径及术后4h（T1）、24h（T2）、7d（T3）、3个月（T4）的动脉直径、内瘘血流量及手术成功率；比较两组术后48h的镇痛药补救次数、镇痛满意度及麻醉相关并发症。结果CBB组T2、T3、T4的动脉直径[（4．2±0．3）mm、（4．6±0．3）mm、（5．2±0．3）mm]及内瘘血流量[（325±15．2）ml／min、（625±32．5）ml／min、（1125±90．2）ml／min]均较SBB组[（3．8±0．2）mm、（4．1±0．2）mm、（4．7±0．3）mm，（162±9．8）ml／min、（442±20．3）ml／min、（778±40．2）ml／min]明显增加（P〈0．05）；CBB组较SBB组术后48h的镇痛药补救次数减少，镇痛满意度升高（P〈0．05）。结论与单次臂丛神经阻滞相比，连续臂丛神经阻滞可显著减轻肱动脉．贵要静脉人工血管移植内瘘术后疼痛，增加动脉直径及内瘘血流量。

Objective To investigate the effects of ultrasound-guided continuous brachial plexus block on the blood flow in brachial artery-basilic vein arterioven±us graft （AVG）. Methods A total of 78 patients undergoing brachial artery-basific vein AVG were randomly assigned to an experiment group that was received single-injection brachial plexus block （SBB）, or to a control group that was received continuous- injection brachial plexus block group （CBB）. Operation was conducted by ultrasound-guided technique. CBB group used patient-controlled nerve analgesia （PCNA） after surgery. The difference of artery diameter preoperative （ T0 ） , artery diameter, fistula blood flow, and postoperative success at 4 h （ T1 ）, 20 h （ T2 ）, 7 d （ T3 ） , 3 m （ T4 ） were compared between two groups. The remedia painkiller times, analgesia satisfaction and anesthesia-related complication in 48 h were Compared. Results The artery diameter, fistula blood flow at T2, T3, T4 after surgery in CBB group [ （4. 2 ± 0. 3 ） mm, （4.6 ± 0. 3 ） mm, （ 5.2 ± 0. 3 ） mm, （325 ±15.2）mL/min, （625 ±32.5）ml/min, and （1 125 ±90.2）ml/min] were significantly in- creased than those in SBB group [ （ 3.8 ±0. 2 ） mm, （4. 1± 0. 2 ） mm, （4. 7 ± 0. 3 ） mm, （ 162 ± 9. 8 ） ml/ min, （442 ± 20. 3） ml/min, and （778 ± 40. 2） ml/min ] （ P 〈 0. 05 ）. Compared to the group SBB, the remedia painkiller times in 48 h after surgery were significantly decreased, and the analgesia satisfaction was significantly increased in the group CBB （ P 〈 0. 05）. Conclusions Compared to the group SBB, group CBB could significantly relieve postoperative pain, and provide higher blood flow in the braehial artery-basil- ic vein AVG.