临床外科杂志 ›› 2024, Vol. 32 ›› Issue (6): 599-602.doi: 10.3969/j.issn.1005-6483.2024.06.012

• 论著 • 上一篇    下一篇

连续臂丛阻滞镇痛的抗交感效应对预防断指再植术后血管危象的研究

徐杨 江伟 董蕙莹   

  1. 200233 上海,上海交通大学附属第六人民医院麻醉科(徐杨、江伟),人力资源处(董蕙莹)
  • 收稿日期:2024-04-11 出版日期:2024-06-20 发布日期:2024-06-20
  • 通讯作者: 董蕙莹,Email:superdhy88@163.com
  • 基金资助:
    上海市卫生健康委员会卫生行业临床研究专项(202240154)

The anti-sympathetic effect of continuous brachial plexus block on the prevention of vascular crisis after digital replantation

XU Yang,JIANG Wei,DONG Huiying   

  1. Department of Anesthesiology,Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200233,China
  • Received:2024-04-11 Online:2024-06-20 Published:2024-06-20

摘要: 目的 评价连续臂丛阻滞(continuous brachial plexus blocks,CBPB)的抗交感、扩血管效应对断指再植术后血管危象的预防作用。方法 2023年1月~2023年12月行断指再植术的病人60例,采用抽签分组法分为对照组(30例,40指,静脉自控镇痛)和研究组(30例,44指,连续臂丛阻滞镇痛)。比较两组断指再植术后即刻、24小时及48小时再植手指皮温及患肢肱动脉血流动力学参数、血管危象的发病率。结果 研究组术后24小时及48小时皮温分别为(31.29±2.14)℃和(32.16±2.34)℃,均显著高于对照组的(28.93±1.98)℃和(30.03±2.52)℃,两组比较差异有统计学意义(P<0.05);肱动脉血流动力学指标方面,研究组术后24小时和48小时的收缩期峰速度分别为(91.45±.32.13)cm/s、(90.34±.30.86)cm/s,舒张末期速度分别为(20.87±9.95)cm/s、(21.35±9.74)cm/s,平均速度分别为(38.63±12.53)cm/s、(40.53±13.30)cm/s,血流量分别为(8.95±2.57)ml/s、(8.10±2.18)ml/s,动脉面积分别为(0.23±0.08)cm2、(0.21±0.06)cm2,阻力指数分别为0.73±0.23、0.75±0.34,对照组术后24小时和48小时的收缩期峰速度分别为(53.50±.19.24)cm/s、(52.64±.17.89)cm/s,舒张末期速度分别为(13.62±3.16)cm/s、(15.38±4.33)cm/s,平均速度分别为(20.26±8.64)cm/s、(21.36±8.36)cm/s,血流量分别为(3.95±1.49)ml/s、(4.23±1.35)ml/s,动脉面积分别为(0.18±0.05)cm2、(0.17±0.05)cm2,阻力指数分别为0.89±0.21、0.90±0.28,两组比较差异均有统计学意义(P<0.05);研究组术后48小时内血管危象的发病率为4.55%,显著低于对照组的35.00%,两组比较差异有统计学意义(P<0.05)。结论 CBPB的抗交感效应可增加再植手指血流灌注,降低血管危象的发病率。

关键词: 连续臂丛阻滞;断指再植;皮温;血管危象

Abstract: Objective The present study aimed to evaluate the anti-sympathetic and vasodilator effects of continuous brachial plexus block(CBPB) on the prevention of vascular crisis after finger replantation.Methods Sixty patients who underwent amputation finger replantation in our hospital from January 2023 to December 2023 were selected and divided into control group(30 cases,40 fingers,patient controlled intravenous analgesia) and study group(30 cases,44 fingers,continuous brachial plexus block analgesia) according to the postoperative analgesia.The skin temperature of the replantation finger and the hemodynamics parameters of the brachial artery of the affected limb were compared immediately,24 hours and 48 hours after replantation.The incidence of vascular crisis was compared between the two groups.Results Skin temperature of replanted fingers in the study group was (31.29±2.14)℃ and (32.16±2.34)℃ at 24h and 48h after surgery,respectively,which were significantly higher than that in the control group[(28.93±1.98)℃ and (30.03±2.52)℃,P<0.05].In terms of humeral arterial hemodynamics of the study group,the peak systolic velocity at 24 hours and 48 hours after operation was (91.45±.32.13)cm/s and(90.34±.30.86)cm/s,respectively,the data of end-diastolic velocity was (20.87±9.95)cm/s and(21.35±9.74)cm/s,respectively,the mean velocity was (38.63±12.53)cm/s and(40.53±13.30)cm/s,respectively,the blood flow was(8.95±2.57)ml/s and(8.10±2.18)ml/s,respectively,the artery area was(0.23±0.08)cm2 and(0.21±0.06)cm2],respectively,the drag index was (0.73±0.23) and (0.75±0.34),respectively.While,in the control group,the ,the peak systolic velocity was (53.50±.19.24)cm/s and(52.64±.17.89)cm/s,respectively,the data of end-diastolic velocity was (13.62±3.16)cm/s and(15.38±4.33)cm/s,respectively,the mean velocity was (20.26±8.64)cm/s and(21.36±8.36)cm/s,respectively,the blood flow was (3.95±1.49)ml/s and(4.23±1.35)ml/s,respectively,the artery area was (0.18±0.05)cm2 and(0.17±0.05)cm2,respectively,the drag index was (0.89±0.21) and (0.90±0.28),respectively.The difference between the two groups was statistically significant(P<0.05).The incidence of vascular crisis within 48 hours after surgery was 4.55% in the study group,which was significantly lower than 35.00% in the control group(P<0.05).Conclusion CBPB can increase blood perfusion of replanted fingers and reduce the incidence of vascular crisis.

Key words: continuous brachial plexus block;digital replantation;skin temperature;vascular crisis

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