百万分之一浓度肾上腺素加局麻行全清醒手外科手术的临床应用  

Clinical application of 1∶1,000,000 epinephrine concentration combined with the wide-awake local anesthesia in hand surgery

作　　者：李一 李学渊 胡浩良 周晓玲 田敏涛 俞淼 刘林海 李苗钟 LI Yi;LI Xueyuan;HU Haoliang(Department of Hand Surgery,Ningbo 6th Hospital,Ningbo 315000,China)

机构地区：[1]宁波第六医院手外科,浙江宁波315000

出　　处：《全科医学临床与教育》2021年第4期325-328,共4页Clinical Education of General Practice

摘　　要：目的介绍百万分之一浓度的肾上腺素加局麻下全清醒手术在急诊手外伤及手外科其他常见疾病中的临床应用,探讨其安全性及临床效果。方法选取手外科手术患者118例,均应用1∶1000000肾上腺素联合0.2%利多卡因溶液对手术部位进行局部浸润注射,术中评估麻醉起效时间、局麻药物使用量、术中出血情况、手术时间,同时使用视觉模拟评分法(VAS)对术中和术后的疼痛进行评估,术后评估术区及肢体远端血运情况。结果术中平均麻醉起效时间约为(8.71±2.62)min,局麻药物注射剂量5~80 ml,术中术野基本无血47例,出血极少51例,出血可以接受17例,出血较多3例。术中患者VAS评分<3分有112例,术中患者VAS评分>3分有6例患者,予追加局部麻醉或加用少量丙泊酚或右美后缓解;术后患者VAS评分>3分有31例,平均(3.54±0.51)分,术后患者VAS评分<3分有87例,平均(1.12±0.10)分。术后仅1例再植手指术后肌腱松解,发生指体一过性苍白,约6 h后逐渐缓解。其余患者术区及肢体远端皮肤血运良好。结论百万分之一浓度的肾上腺素加局麻下全清醒手术可达到良好的麻醉效果及无血手术野,无需使用止血带,术后局部及指端微循环基本不受影响,在急诊手外伤及手外科其他常见疾病中应用安全有效。Objective To introduce the clinical application,security and clinical effect of 1:1,000,000 epinephrine concentration combined with the wide awake local anesthesia in the emergency hand trauma and other common diseases in hand surgery.Methods Totally 118 cases were injected with 1:1,000,000 epinephrine and 0.2%lidocaine.The onset time of anesthesia,local anesthetic dosage,bleeding in operation,and the operation time were recorded.The intraoperative and postoperative pain were evaluated by visual analogue scale(VAS),and the blood supply of the operation area and distal limb were evaluated after the operation.Results The average onset time of anesthesia in 118 patients was(8.71±2.62)min.The dose of local anesthetic drugs was 5~80 ml.In intraoperation,47 cases had totally bloodless in the operative field,51 cases had minimal bleeding,17 cases had acceptable bleeding,and 3 cases bloody operative field.There were 112 patients with intraoperative VAS score<3,6 cases with intraoperative VAS score>3,and they were relieved after additional local anesthesia or a small amount of propofol or dexamethasone.There were 31 patients with postoperative VAS score>3,with an average of(3.54±0.51),and 87 patients with postoperative VAS score<3,with an average of(1.12±0.10).After the operation,only one case of replantation of the finger had tendon release and transient pallor of the finger body,which gradually relieved after about 6 hours.The skin blood supply of the other patients was good.Conclusion 1∶1,000,000 epinephrine concentration combined with the wide-awake local anesthesia can achieve good anesthetic effect and bloodless surgical field with no tourniquet,and postoperative local and fingertip microcirculation is basically unaffected,which is safe and effective in the emergency hand trauma and other common diseases hand surgery.

关 键 词：全清醒局麻手术 肾上腺素 手外科手术 

分 类 号：R614[医药卫生—麻醉学]