超声联合神经刺激仪引导下连续肌间沟臂丛神经阻滞汇编.doc

超声联合神经刺激仪引导下连续肌间沟阻滞对再植术后手指组织灌注的影响 (张国强 徐 杨 姚 军 【摘要】目的 评估超声联合神经刺激仪引导下行肌间沟臂丛连续阻滞断指再植术后再植手指组织灌注的影响。方法 选择急诊断指再植术后患者60例排除年龄6岁既往有雷诺综合征病史美国麻醉医师分级Ⅱ级以上伴严重合并伤。将患者随机分入研究组和对照组，每组30例。研究组患者应用超声联合神经刺激仪引导下行肌间沟臂丛置管，术后接电子镇痛泵行持续镇痛，镇痛配方为0.2％罗哌卡因共200 mL，维持量5 mL/h，术后48 h拔除导管；对照组患者术后单纯在神经刺激仪引导下行以上操作。术后12、24、36、48 h记录患者再植手指远端的皮温对应健侧手指皮温再植手指的皮肤颜色、肿胀程度毛细血管充盈时间疼痛视觉模拟评分（VAS）。结果 在术后12、24、3648 h各时间点，研究组皮温差绝对值均小于对照组（P0.05）再植手指的组织灌注评分均显著高于对照组（P0.05）。研究组48 h内的疼痛VAS均维持在2~4分对照组维持在~7分。断指病房监护室住院天数总住院天数差异无统计学（P0.05）。对照组中有2例患者因血管危象行二次探查手术，研究组无类似不良事件两组患者均未出现再植指坏死的病例。结论 超声联合神经刺激仪引导下肌间沟臂丛连续阻滞为断指再植术后患者提供了良好的镇痛，同时能升高再植手指皮温改善灌注，防止术后血管危象的发生。 【关键词】超声引导；神经刺激仪；连续神经阻滞；断指再植；组织灌注 Effect of ultrasound and nerve stimulator guided continuous nerve block for interscalene brachial plexus on blood perfusion for amputated finger replantation Guoqiang ZHANG，. Department of Anesthesiology，Le Cong Hospital，Guangzhou Medical University，Foshan 528315，Guangdong，China：Jun Yao，Department of Anesthesiology，The Sixth People’s Hospital Affiliated to Shanghai Jiaotong University,Shanghai,China Corresponding author：Jun Yao.E-mail: guoxinger@126. com 【Abstract】Objective The present study aimed to investigate the influence of ultrasound versus nerve stimulator guided continuous nerve block for interscalene brachial plexus on blood perfusion for amputated finger replantation. Methods ixty patients undergoing finger replantation，aged older than 6 years，no history of Raynauds syndrome，American Society of Anesthesiologists(ASA)I to II，no combination of serious traumawere randomized into control group and study group(n=30).Under ultrasound versus nerve stimulatorguided，continuous target nerve block analgesia of interscalene brachial plexus was operated for study group，followed by an infusion of 5 ml per hour for up to 2 days.Control group received continuous nerve block for interscalene brachial plexus only guided by versus nerve stimulator.The difference between the skin temperature of the reconstructive site and contralateral non-sur