连续臂丛神经阻滞镇痛对断指再植术后血管危象及疼痛评分影响  

Effect of continuous brachial plexus block analgesia on vascular crisis and pain score after replantation of severed finger

作　　者：费圣强 李伟[1] 刘晓江 张欣[1] FEI Shengqiang;LI Wei;LIU Xiaojiang;ZHANG Xin(Department of External Hand Anesthesia,971 Hospital of the People's Liberation Army,Qingdao,Shandong,266100,China)

机构地区：[1]中国人民解放军第971医院手外麻醉科,山东青岛266100

出　　处：《当代医学》2023年第30期78-82,共5页Contemporary Medicine

摘　　要：目的探讨连续臂丛神经阻滞镇痛对断指再植术后血管危象及疼痛评分影响。方法选取2017年10月至2021年3月中国人民解放军第971医院接受断指再植术的97例患者作为研究对象,随机分为对照组(n=48)与观察组(n=49)。对照组给予静脉镇痛,观察组给予连续臂丛神经阻滞镇痛,比较两组数字分级评分法(NRS)、毛细血管充盈时间、血氧饱和度(SpO_(2))、患侧掌心温度、双侧掌心温度差、动脉搏动指数(PI)、血管危象发生率及断肢再植成活率。结果术后8、16、24h,两组NRS评分均高于术后4h,观察组术后48h高于术后4h,且术后16h,两组NRS评分均高于术后8h,观察组术后24h高于术后8h,对照组术后48h低于术后8h,且术后48h,两组NRS评分均低于术后24h,差异有统计学意义(P<0.05),两组内其余时间点NRS评分比较差异无统计学意义。术后4、48h,两组NRS评分比较差异无统计学意义;术后8、16、24h,观察组NRS评分低于对照组,差异有统计学意义(P<0.05)。观察组手术侧手部末梢毛细血管充盈时间短于对照组,血氧饱和度高于对照组,差异有统计学意义(P<0.05)。术后24、48h,对照组患侧掌心温度高于术后4、8h,动脉PI低于术后4、8、16h,且术后48h,对照组动脉PI低于术后24h,差异有统计学意义(P<0.05);术后8、16、24、48h,观察组患侧掌心温度高于术后4h,术后16、24h,观察组动脉PI低于术后4、8h,术后48h,观察组患侧掌心温度差高于术后8h,双侧掌心温度差、动脉PI均低于术后4、8、16、24h,差异有统计学意义(P<0.05)。术后4、8、16、24、48h,观察组患侧掌心温度、双侧掌心温度差、动脉PI均高于对照组,差异有统计学意义(P<0.05)。观察组血管危象发生率为8.16%,低于对照组的22.92%,差异有统计学意义(P<0.05)。观察组断指再植成活率100.00%,高于对照组的87.50%,差异有统计学意义(P<0.05)。结论连续臂丛神经阻滞镇痛对断指再植术后患者临床疗Objective To investigate the effect of continuous brachial plexus block analgesia on vascular crisis and pain score after replantation of severed fingers.Methods 97 patients who underwent replantation of severed fingers in the 971 st Hospital of the Chinese People's Liberation Ar-my from October 2017 to March 2021 were selected as the study subjects,and they were randomly divided into the control group(n=48)and the ob-servation group(n=49).The control group was given intravenous analgesia,and the observation group was given continuous brachial plexus block analgesia,The numerical rating scale(NRS),capillary filling time,blood oxygen saturation(SpO_(2)),affected palm temperature,bilateral palm temper-ature difference,arterial pulsatility index(PI),incidence of vascular crisis and survival rate of limb replantation were compared between the two groups.Results The NRS scores of the two groups at 8,16 and 24 h after operation were higher than those at 4 h after operation,the NRS scores of the observation group at 48 h after operation were higher than those at 4 h after operation,and the NRS scores of the two groups at 16 h after operation were higher than those at 8 h after operation,the NRS scores of the observation group at 24 h after operation were higher than those at 8 h after opera-tion,the NRS scores of the control group at 48 h after operation were lower than those at 8 h after operation,and the NRS scores of the two groups at 48 h after operation were lower than those at 24 h after operation,the difference was statistically significant(P<0.05).There was no significant differ-ence in NRS scores between the two groups at other time points.At 4 and 48 h after operation,there was no significant difference in NRS score be-tween the two groups;at 8,16 and 24 h after operation,the NRS score of the observation group was lower than that the control group,and the differ-ence was statistically significant(P<0.05).The capillary filling time of the surgical side in the observation group was shorter than that in the contr

关 键 词：连续臂丛神经阻滞 术后镇痛 断指再植术 血管危象 疼痛评分 预后影响 

分 类 号：R614[医药卫生—麻醉学]