超声下肋锁间隙连续臂丛阻滞在断指再植术后镇痛效果及对疼痛介质指标影响  

Effectiveness of Ultrasound-guided Continuous Brachial Plexus Block at Costoclavicular Space for Postoperative Analgesia in Finger Replantation and Its Influence on Pain Mediator Levels

作　　者：郑威 黄建东 姚明明 何巍[1] ZHENG Wei;HUANG Jiandong;YAO Mingming;HE Wei(Affiliated Hospital of Beihua University,Jilin 132011,China)

机构地区：[1]北华大学附属医院,吉林吉林132011

出　　处：《北华大学学报(自然科学版)》2025年第3期366-371,共6页Journal of Beihua University(Natural Science)

基　　金：吉林省卫生与健康技术创新项目(2020J019)。

摘　　要：目的分析超声下肋锁间隙连续臂丛阻滞在断指再植术后镇痛中的应用效果及对疼痛介质指标影响。方法选择100例断指再植术患者展开回顾性研究,根据连续臂丛阻滞入路方法不同将患者分为3组:观察组33例,接受肋锁间隙入路;对照1组35例,接受锁骨下入路;对照2组32例,接受肌间沟入路,比较3组患者术后不同观测点视觉模拟自评量表(VAS)评分、臂丛神经分支(肌皮神经、桡神经、正中神经、尺神经)感觉及运动阻滞完善率、疼痛介质指标[β-内啡肽(β-EP)、前列腺素E 2(PGE 2)、P物质(SP)]、舒芬太尼用量、并发症总发生率、血管危象发生率。结果观察组患者术后4、8、16、32 h VAS评分低于对照1组、对照2组(P<0.05);观察组患者术后4、8、16、32 h肌皮神经感觉阻滞完善率均高于对照1组、对照2组(P<0.05);观察组患者阻滞即刻,术后4、8、16、32 h桡神经、尺神经感觉阻滞完善率均高于对照1组、对照2组(P<0.05);观察组患者阻滞即刻,术后4、8 h正中神经感觉阻滞完善率均高于对照1组、对照2组(P<0.05)。3组患者阻滞即刻、术后32 h肌皮神经、桡神经、正中神经、尺神经运动阻滞完善率比较差异无统计学意义(P>0.05);观察组患者术后4、8、16 h肌皮神经、桡神经、正中神经、尺神经运动阻滞完善率均高于对照1组、对照2组(P<0.05)。术后24 h,观察组患者血清β-EP水平高于对照1组、对照2组(P<0.05),血清PGE 2、SP水平低于对照1组、对照2组(P<0.05)。观察组、对照1组患者并发症总发生率均低于对照2组(P<0.05)。观察组患者血管危象发生率低于对照1组、对照2组(P<0.05)。结论超声下肋锁间隙连续臂丛阻滞可有效减轻断指再植术患者术后疼痛感,抑制PGE 2等疼痛介质释放,感觉、运动阻滞持续稳定,且并发症、血管危象发生率较低,可为患者提供安全、有效、持续的术后镇痛。Objective To analyze the application effects of ultrasound-guided continuous brachial plexus block at the costoclavicular space for postoperative analgesia in finger replantation and its influence on pain mediator levels.Methods A retrospective study was conducted on 100 patients undergoing fingers replantation,and the patients were divided into three groups according to the different methods of continuous brachial plexus block access:33 cases in observation group received the intercostal clavicular approach;35 cases in control group 1 received the subclavian approach;and 32 cases in control group 2 received the interosseous sulcus approach.Compared the visual analog scale(VAS)scores at different observational points,the block success rate of sensory and motor of the brachial plexus nerve branches(musculocutaneous,radial,median and ulnar nerves),pain mediator indexes[β-endorphin(β-EP),prostaglandin E 2(PGE 2),substance P(SP)],the dosage of sufentanil,the overall incidence of complications,and the incidence of vascular crises among three groups of patients postoperatively.Results The VAS scores of observation group of patients at 4,8,16 and 32 h postoperatively were lower than those of control group 1 and control group 2(P<0.05).The block success rate of musculocutaneous nerve sensory at 4,8,16 and 32 h postoperatively in observation group of patients was higher than that in control group 1 and control group 2(P<0.05).The immediate block,and the block success rate of adial nerve and ulnar nerve at 4,8,16 and 32 h postoperatively in observation group of patients were higher than those in control group 1 and control group 2(P<0.05).The immediate block,and the block success rate of median nerve sensory at 4 and 8 h postoperatively in observation group of patients were higher than those in control group 1 and control group 2(P<0.05).There was no statistically significant difference in immediate block,and the block success rate of the musculocutaneous,radial,median and ulnar nerves at 32 h postoperatively in three gr

关 键 词：超声 肋锁间隙 臂丛神经阻滞 断指再植术 镇痛效果 

分 类 号：R614[医药卫生—麻醉学]