用病人自控镇痛技术治疗手指再造术后顽固性血管痉挛

Patient controlled intravenous angesia PCIA on obstinate vasospasm after severed digital replantation or reconstruction of digits

目的 研究用长效腋路臂丛阻滞复合病人自控镇痛(patient controlled intravenous analgesia,PCIA)技术,治疗手指再造患者术后顽固性血管痉挛的疗效并分析其作用。方法 1325例1946再造患者,根据开启PCA泵时间不同随机分为对照组(A组):475例684指,用传统哌替啶镇痛。观察组(B组):425例627指,手术结束后开启PCA泵。观察组(C组):425例635指,手术开始前开启PCA泵。重点观察术后48 h内用VAS(视觉模拟评分法)、Ramesay(镇静评分法)评分。168 h内观察顽固性血管痉挛率、患指存活率及不良反应。结果 与对照组相比,观察组镇痛VAS评分较低(C<B);镇静Ramesay评分较高(C>B),顽固性血管痉挛率较低(C<B),顽固性血管痉挛患指存活率较高(C>B),恶心、呕吐、头晕发生率较低(C<B)。结论 长效腋路臂丛阻滞复合PCIA技术能有效地缓解病人术后疼痛、有明显的镇静作用,故顽固性血管痉挛发生率低,再造指存活率高。

Objective To study the treatment outcome of sustained brachial plexus block via axillary combined with PCIA on obstinate vasospasm after replantation and reconstruction of digits. Methods The patients (1 325 cases with 1 946 digits) were divided into control group (A) and two experimental groups(B and C) .In control group(A) , 475 cases with 684 digits were administered by dolantin postoperatively. In group B, 425 cases with 627 digits were administered PCIA pump postoperatively, and in group C, 425 cases with 635 digits were administered PCIA pump preoperan'vely . The VAS, Ramesay scoring were observed within 48 hrs postoperatively, and the incidence rate of obstinate vasospasm, survival rate and side-effect were observed within 168 hrs postoperatively . Results Compared with control group,there was lower VAS, higher sedation ramesdy scoring, lower incidence rate of vasospasm, higher survival rate in patients with obstinate vasospasm and lower incidence of nausea, vomiting and dizziness in experimental group. Conclusion Administration of sustained brachial plexus block via axillary combined with PCIA can effectively lead to evident analgesia and sedation, resulting in lower incidence rate of vasospasm and higher survival rate in patients with severed digital replantation or reconstruction of digits.