断肢再植术应用利多卡因联合罗哌卡因的麻醉效果

Anesthesia effect of lidocaine combined with ropivacaine in amputated limb replantation

目的 探究断肢再植术中应用利多卡因联合罗哌卡因的麻醉效果。方法 选取2019年1月至2020年4月本院收治的100例断肢再植术患者作为研究对象,按照平衡序贯法分为对照组(n=49)与观察组(n=51)。对照组采用罗哌卡因单纯麻醉,观察组采用利多卡因联合罗哌卡因麻醉,比较两组麻醉效果、断指再植成活率、视觉模拟评分法(VAS)评分、血流动力学及血清C反应蛋白(CRP)水平。结果 观察组麻醉总有效率、断指再植成活率均明显高于对照组,差异有统计学意义(P<0.05)。术后2、4、12、24 h,观察组VAS评分均低于对照组,差异有统计学意义(P<0.05)。诱导时,观察组收缩压高于对照组,对照组心率、舒张压及平均动脉压均高于麻醉前,差异有统计学意义(P<0.05)。插管时、拔管时,观察组心率、平均动脉压均低于对照组,收缩压、舒张压均高于对照组,对照组心率、平均动脉压均高于麻醉前,收缩压、舒张压均低于麻醉前,差异有统计学意义(P<0.05)。术毕、术后1、2 h,观察组CRP水平均低于对照组,差异有统计学意义(P<0.05)。结论 断指再植术中实施利多卡因联合罗哌卡因麻醉方案麻醉效果显著,可减轻患者围手术期的疼痛感,降低CRP水平,值得临床推广应用。

Objective To explore the anesthesia effect of lidocaine combined with ropivacaine in amputated limb replantation.Methods 100 patients with severed limb replantation who were admitted to our hospital from January 2019 to April 2020 were selected as the research subjects,and they were divided into the control group(n=49) and the observation group(n=51) according to the balanced sequential method.The control group was anesthetized with ropivacaine alone,and the observation group was anesthetized with lidocaine combined with ropivacaine,the anesthesia effect,survival rate of severed finger replantation,visual analogue scale(VAS) score,hemodynamics and serum C-reactive protein(CRP) levels were compared between the two groups.Results The total effective rate of anesthesia and the survival rate of severed finger replantation in the observation group were significantly higher than those in the control group,and the differences were statistically significant(P<0.05).At 2,4,12,and 24 h after operation,the VAS scores of the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).During induction,the systolic blood pressure in the observation group was higher than that in the control group,and the heart rate,diastolic blood pressure and mean arterial pressure in the control group were higher than those before anesthesia,and the differences were statistically significant(P<0.05).During intubation and extubation after anesthesia,the heart rate and mean arterial pressure of the observation group were lower than those of the control group,the systolic blood pressure and diastolic blood pressure were higher than those in the control group,the heart rate and mean arterial pressure in the control group were higher than those before anesthesia,and the systolic blood pressure and diastolic blood pressure were lower than those before anesthesia,and the difference was statistically significant(P<0.05).After operation,1 and 2 h after operation,the CRP levels in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).Conclusion Lidocaine combined with ropivacaine anesthesia has significant anesthesia effect in the replantation of severed fingers,which can reduce the perioperative pain of patients and reduce the level of CRP,which is worthy of clinical application.