CAJ | 학술논문

目的探讨超声引导臂丛神经穿刺置管在断指再植术后镇痛的指导价值.方法 80例急诊拟行一指或两指断指再植手术的患者(男58例,女22例),年龄17～67岁,ASA Ⅰ～Ⅲ级,无颈部外伤及臂丛神经损伤,按术后镇痛方式随机分为连续臂丛神经阻滞(PCBA组)和静脉镇痛组(PCIA组).采用视觉模糊评分(VAS)对两组患者术后24 h和48 h的镇静、镇痛程度进行评价,并记录出现恶心、呕吐、膈神经阻滞等并发症的例数.结果所有患者均能舒适地接受超声引导臂丛神经穿刺过程,术中麻醉效果确切.PCBA组超声引导臂丛穿刺置管过程顺利,全部成功.PCBA组与PCIA组比较,VAS评分和镇静程度差异有显著统计学意义(P<0.01),PCIA组的血管痉挛及恶心、呕吐发生率高于PCBA组.结论应用超声引导臂丛神经穿刺置管具有神经定位准确,成功率高;且PCBA组更好地改善了再植指的血运供应,提高了再植指的成活率,避免了加用阿片类药物引起的恶心、呕吐等并发症,增加了患者的舒适度.
목적 탐토초성인도비총신경천자치관재단지재식술후진통적지도개치.방법 80례급진의행일지혹량지단지재식수술적환자(남58례,녀22례),년령17～67세,ASA Ⅰ～Ⅲ급,무경부외상급비총신경손상,안술후진통방식수궤분위련속비총신경조체(PCBA조)화정맥진통조(PCIA조).채용시각모호평분(VAS)대량조환자술후24 h화48 h적진정、진통정도진행평개,병기록출현악심、구토、격신경조체등병발증적례수.결과 소유환자균능서괄지접수초성인도비총신경천자과정,술중마취효과학절.PCBA조초성인도비총천자치관과정순리,전부성공.PCBA조여PCIA조비교,VAS평분화진정정도차이유현저통계학의의(P<0.01),PCIA조적혈관경련급악심、구토발생솔고우PCBA조.결론 응용초성인도비총신경천자치관구유신경정위준학,성공솔고;차PCBA조경호지개선료재식지적혈운공응,제고료재식지적성활솔,피면료가용아편류약물인기적악심、구토등병발증,증가료환자적서괄도.
Objective To study the ultrasound-guided brachial plexus catheterization finger replantation in the guidance ofthe value of postoperative analgesia.Methods 80 cases of emergency means to be a line or two referring to digital replantation patients(male 58 cases,22 cases of women),aged 17～67-year-old,ASA I ～III-class,non-traumatic neck and brachial plexus injury,by means of postoperative analgesia were randomly divided into continuous brachial plexus block(PCBA group)and intravenous analgesia group(PCIA group).Visual analog scale(VAS)were patients of the 24 h and 48 h after the sedative and analgesic evahation of the extent of,and record the emergence of nausea,vomiting,complications such as phrenic nerve block several of the cases.Results All patients were able to comfortably accept the ultrasound-guided brachial plexus puncture process,the exact effect of intraoperative anesthesia.that of PCBA Group of ultrasound-guided brachial plexus puncture the smooth process,all successfully.PCBA group compared with the PCIA group,VAS score and sedation extent there was a significant difference(P<0.01),PCIA vasospasm group and incidence of nausea and vomiting was higher than PCBA Group.Conclusion Ultrasound-guided brachial plexus nerve catheterization with positioning accuracy,the success rate is high;and PCBA group replantation better means to improve the blood supply,improve the survival rate of replanted digits to avoid the added opioid-induced nausea,vomiting and other complications,increase patient comfort.