超声引导下留置持续外周神经阻滞导管的院外管理：620例患者的经验总结.pdfVIP

84 《麻醉与镇痛》中文版 2008年2月 第一期 超声引导下留置持续外周神经阻滞导管的院外管理： 620例患者的经验总结 Jeffrey D．Swenson，MD ，Nathan Bay，MD’，Evelyn Loose，MD ， Byron Bankhead，MD ，Jennifer Davis，MD’，Timothy C．Beals，MD ， Nathamel A．Bryan，MD ，Robert T．Burks，MD ，Pa~ick E．Greis，MD Departments of~aesthesiology，Health Science Center and Orthopaedic Surgery，Orthopaedic Center，University of Utah，Salt Lake City，UT 摘要 背景 持续外周神经阻滞(continuous peripheral nerve block，CPNB)是骨科手术术后镇痛的最佳选择，但鉴于对置 管相关并发症的顾虑，该方法并不常规用于门诊患者，同时在此情况下很难保证患者随时-9医生进行联系。本研究对620例按 照预设方案接受CPNB的门诊病例进行了分析。方法 所有导管均在超声直视下置入。每个患者在手术前都接受充分的口头和 书面指导，手术后由麻醉医生提供随时的电话随访服务。所有患者手术后第l天都会在家中接到电话随访。另外，每个患者出 院后两周内要接受外科医生复查。结果 620例病例中，190例为肌间沟(臂丛神经)置管，206为髂筋膜(股神经)置管，224例 为胭窝(坐骨神经)置管。2例患者(0．3％)出现神经阻滞相关的并发症；其症状在手术后6周内得到了缓解；26例患者(4．2％) 需要麻醉医生的手术后干预；l例患者返回医院拔除导管。结论 此项对大样本门诊患者接受CPNB治疗的研究发现，仅有极 少部分患者需要麻醉医生干预。同样，患者可以在家中自行管理和拔除导管而不需要额外随访。这一发现说明给予充分的手术 前指导以及与医生进行电话沟通，患者可以舒适地在家中管理并拔除CPNB导管。 Abstract BACKGROUND：Continuous peripheral nerve block(CPNB)is an optireal choice for analgesia after orthope— dic procedures，but is not commonly used in outpatients because of concern regarding the possibility of catheter—related compli- cations．In addition，itmaybe difficultto provide adequate patient access to physicians in this setting．We present 620 outpa- tients who were treated、Jl，ith CPNB using an established protoco1．METHODS：All catheters were placed using direct ultra。 sound visualization．These patients received extensive oral and written preoperative instruction and were provided continuous telephone aocess to the anesthesiologist during the postoperative period．All patients were also contacted at home by telephone on the first postoperative day．In addition，each patient was seen and examined by the surgeon within 2 wk of hospital dis。 charge．RESULTS：Ofthe 620 patients，therewere 190 interscalene(brachialplexus)，206 fasdailiaca(femoralnerve)