手背皮神经分布与静脉穿刺疼痛程度的相关性研究(英文)

A correlation study between the distribution of nerves on the dorsum of hand and the degree of the pain of venipuncture

背景:静脉穿刺是临床治疗最常用的方法之一。手背静脉又是最常选用的静脉穿刺部位。但这种治疗方法是一种有创伤性的操作,它给患者带来一定的痛苦。目前还较少有人从手背静脉与手背皮神经分布、走向规律与穿刺部位疼痛性关系进行研究。目的:探讨手背静脉穿刺疼痛程度最低的最佳部位,减轻患者疼痛。设计:随机对照的前瞻性研究。地点和对象:资料收集于广州医学院荔湾医院,所选取的对象有12例24侧成人防腐标本和在本院住院及门诊静脉穿刺的3011例次患者。方法:首先对24侧成人手背标本进行解剖、观察,找出手背静脉与皮神经分布规律,进行分区。以随机方式对本院2000-08/2001-02就诊留医患者2980例按不同分区部位进行静脉穿刺。采用双盲法对穿刺患者进行疼痛评分(简化Mcgill疼痛评分法)。分组进行相互对照,方差分析法对数据进行分析。主要观察指标:解剖观测结果及静脉穿刺疼痛评分结果。结果:手背解剖研究发现桡骨茎突、尺骨茎突及第三掌骨头所形成的三角形区域内神经与静脉呈交叉关系,神经分布稀疏(可称为乏神经区),此区域内静脉穿刺疼痛分值明显低于其他区域(P<0.01)。结论:乏神经区内神经分布稀疏,是减少手背静脉穿刺疼痛的最佳部位。

BACKGROUND:Venipuncture is one of the most common methods in the clinical treatment. Veins on the dorsum of the hand are the most common positions selected for venipuncture.However,this method is a traumatic operation,which causes certain pain to the patients. There are few correlation researches about the distribution,directional rules of the veins and nerves of dorsum of the hand and the pain of the venipuncture position. OBJECTIVE:To explore the optimal position on the dorsum of the hand with the lowest degree of pain during venipuncture to relieve the pain for the patients. DESIGN:A randomized controlled prospective study was conducted. SETTING and PARTICIPANTS:Twelve cases and 24 sides of preserved adult specimens and 3 011 cases of venipunctures were selected from Central Hospital of Liwan District,Guangzhou Medical College. METHODS:Firstly,24 sides of adult dorsum of hand specimens were anatomised and observed for the rules of the distribution of the veins and nerves of the dorsum of hand to divide the subareas.Totally 2 980 patients admitted from August 2000 to February 2001 were randomly allocated into different groups for venipuncture at different subareas.The pain degree was evaluated by Mini Mcgill pain score through double blind methods after venipuncture.The results of different groups were compared. MAIN OUTCOME MEASURES:Anatomical observation and pain scores of venipuncture. RESULTS:The anatomy of dorsum of hand study found that veins and nerves in the triangle area circled by the styloid process of radius,styloid process of ulna and the head of the third metacarpal were in a crossover relationship,and the distribution of the nerve was sparse,which could be called as a lack of nerve area. Therefore,the pain score of venipuncture in this area was significantly lower than other areas(P< 0.01). CONCLUSION:The lack of nerve area with sparse nerve distribution is an optimal position for venipuncture of the dorsum of the hand to relieve pain.