發(fā)布時間：2018-06-10 15:27

  本文選題：超聲引導 + 連續(xù)神經(jīng)阻滯　； 參考：《上海醫(yī)學》2015年04期

【摘要】：目的應(yīng)用超聲引導下肘部橈神經(jīng)、尺神經(jīng)和正中神經(jīng)置管連續(xù)阻滯,對斷指再植術(shù)后患者進行精準的靶神經(jīng)鎮(zhèn)痛,探討該方法在術(shù)后48h內(nèi)的鎮(zhèn)痛效果,及其對再植手指皮溫和存活率的影響。方法選擇急診行斷指再植手術(shù)的患者60例,性別不限,年齡6歲,既往均未長期服用抗凝藥物,離斷手指≤3根,美國麻醉醫(yī)師協(xié)會分級Ⅰ或Ⅱ級,無嚴重合并傷。將患者隨機分入研究組和對照組,每組30例。研究組患者于術(shù)后根據(jù)再植手指的不同分別行超聲引導下肘部橈、尺和正中神經(jīng)單獨或聯(lián)合置管,接鎮(zhèn)痛泵行持續(xù)鎮(zhèn)痛,鎮(zhèn)痛配方為0.2%羅哌卡因共100mL,注射速度為2mL/h,術(shù)后48h拔除導管。對照組患者術(shù)后按需予肌內(nèi)注射帕瑞昔布20mg鎮(zhèn)痛。分別于術(shù)后即刻和術(shù)后12、24、36、48h各時間點,測量再植手指遠端的皮溫,同時記錄疼痛視覺模擬評分(VAS評分)。分別記錄兩組患者再植手指血管危象發(fā)生率、二次手術(shù)探查率和再植手指存活率。結(jié)果研究組在術(shù)后12、24、36和48h時的疼痛VAS評分均顯著低于對照組同時間點(P值均0.05),再植手指皮溫均顯著高于對照組同時間點(P值均0.05)。對照組的血管危象發(fā)生率(26.7%)和二次手術(shù)探查率(16.7%)均顯著高于研究組(3.3%和3.3%,P值均0.05)。兩組的再植手指存活率均為96.7%,差異無統(tǒng)計學意義(P0.05)。結(jié)論連續(xù)肘部靶神經(jīng)阻滯可根據(jù)患者的具體傷情選擇阻滯橈神經(jīng)、尺神經(jīng)或正中神經(jīng),提供良好的鎮(zhèn)痛,達到擴張血管、增加血液灌注的目的,減少血管危象的發(fā)生。
[Abstract]:Objective to study the analgesia effect of the target nerve after replantation of severed fingers by continuous catheter block of radial nerve, ulnar nerve and median nerve of elbow guided by ultrasound, and to explore the analgesic effect of this method within 48 hours after operation. And its effect on the mild survival rate of finger skin replantation. Methods A total of 60 patients (age 6 years old) who underwent replantation of severed finger were selected. They had not taken anticoagulant drugs for a long time, had not taken anticoagulant drugs for a long time, had broken fingers 鈮，

本文編號：2003697