超声引导下连续星状神经节阻滞在断指再植术后的应用及对术后血管危象的预防作用

Application of Ultrasound-guided Continuous Stellate Ganglion Block in Replantation of Severed Finger and Its Preventive Effect on Postoperative Vascular Crisis

目的:探讨超声引导下连续星状神经节阻滞(Stellate ganglion block,SGB)在断指再植术后的应用及对术后血管危象的预防作用。方法:选择2020年1月-2020年12月医院收治的116例行断指再植术患者为研究对象,以随机数字表法分为对照组(n=58)和研究组(n=58)。两组均采用患侧肌间入路臂丛神经阻滞,之后采用断指再植术,研究组术后采用超声引导下连续SGB 72 h,对照组未行超声引导下连续SGB。比较两组术后即刻(T0)、术后1 h(T1)、术后24 h(T2)、术后72 h(T3)患侧桡动脉血流灌注指数(Perfusion index,PI)及患侧前臂掌心温度,比较两组T0、T2时刻视觉模拟量表(Visual analogue scale,VAS)评分情况,比较两组术后并发症发生情况。结果:T0时刻,两组患侧桡动脉PI、患侧前臂掌心温度比较差异无统计学意义(P>0.05);T1、T2、T3时刻,研究组患侧桡动脉PI、患侧前臂掌心温度均比对照组高,差异有统计学意义(P<0.05)。T0时刻,两组患指VAS评分比较差异均无统计学意义(P>0.05);T2时刻,两组患指VAS评分均低于T0时刻,且研究组低于对照组,差异有统计学意义(P<0.05)。研究组术后并发症总发生率为18.97%低于对照组的37.93%,差异有统计学意义(P<0.05)。结论:超声引导下连续SGB 72 h应用于断指再植术后,能够有效改善患指的掌心温度及PI,能够减轻术后疼痛,有效预防血管危象的发生,且安全可靠。

Objective To investigate the application of ultrasound-guided continuous stellate ganglion block(SGB)after replantation of severed finger and its preventive effect on postoperative vascular crisis.Methods A total of 116 patients undergoing amputated finger replantation who were admitted to the hospital from January 2020 to December 2020 were selected as the research subjects.They were divided into the control group(n=58)and the study group(n=58)by a random number table.Both groups were treated with brachial plexus block via intermuscular approach on the aff ected side,and then replanted with amputated fingers.The study group used ultrasound-guided continuous SGB for 72 hours after surgery,the control group did not undergo continuous SGB under ultrasound guidance.The two groups immediately after operation(T0),1 hour after operation(T1),24 hours after operation(T2),72 hours after operation(T3),the perfusion index(PI)of the aff ected side radial artery and the palm of the aff ected side of the forearm temperature were compared.The VAS scores at T0 and T2 between the two groups were compared.Postoperative complications between the two groups were compared.Results At T0,there were no statistically signifi cant diff erences in the PI of the radial artery on the aff ected side and the temperature of the palm of the forearm on the aff ected side between the two groups(P>0.05).At T1,T2,and T3,the PI of the aff ected side of the radial artery and the temperature of the palm of the aff ected side of the forearm in the study group were higher than those in the control group,the diff erences were statistically signifi cant(P<0.05).At T0,there was no signifi cant diff erence in the VAS scores between the two groups(P>0.05).At T2,the VAS scores of the two groups of patients were lower than at T0,and the study group was lower than the control group(P<0.05).The total incidence of postoperative complications in the study group(18.97%)was lower than that in the control group(37.93%,P<0.05).Conclusion Continuous SGB for 72 hours under ultrasound guidance in patients after replantation of amputated fi ngers can eff ectively improve the palm temperature and PI of the aff ected fi nger,reduce postoperative pain,eff ectively prevent the occurrence of vascular crisis,and is safe and reliable.