影响断指再植术后血管危象独立危险因素分析及芬太尼透皮贴超前镇痛干预效果研究.docVIP

影响断指再植术后血管危象独立危险因素分析及芬太尼透皮贴超前镇痛干预效果研究 　　[摘要] 目的 探究影?断指再植术后血管危象的独立危险因素及芬太尼透皮贴超前镇痛的干预效果。 方法 回顾性分析行断指再植术的220例患者临床资料，按术后发生血管危象情况分为血管危象组（n=48）和非血管危象组（n=172），经Logistics回归分析影响术后血管危象的独立危险因素。另选行断指再植术的220例患者为研究对象，根据手术先后顺序分为常规镇痛组和超前镇痛组（芬太尼透皮贴超前镇痛）各110例；评估其术后疼痛、舒适状况，观察术后6个月再植指成活率、功能。 结果 ①Logistics回归分析显示：性别、年龄、吸烟史、缺血时间、创伤类型、离段平面是血管危象发生的独立危险因素（P0.05）；②术后2 h、6 h、12 h、24 h时，常规镇痛组和超前镇痛组VAS评分均下降（P0.05），超前镇痛组降幅较大（P0.05）；③术后1周时，超前镇痛组VAS-A和SPIEGEL睡眠量表得分低于常规镇痛组（P0.05）；④超前镇痛组断指存活率及再植指功能优良率均高于常规镇痛组（P0.05）。结论 断指再植术后血管危象影响因素多，芬太尼透皮贴剂超前镇痛对术后疼痛效果显著，且有助于改善患者预后状况。 　　[关键词] 断指再植术；血管危象；芬太尼透皮贴；超前镇痛 　　[中图分类号] R658.1 [文献标识码] B [文章编号] 1673-9701（2017）35-0098-04 　　[Abstract] Objective To explore the independent risk factors that affect the vascular crisis after replantation of amputated finger and the intervention effect of preemptive analgesia of fentanyl transdermal patch. Methods The clinical data of 220 patients undergoing replantation of amputated finger were retrospectively analyzed. According to the postoperative vascular crisis， they were divided into vascular crisis group（n=48） and non-vascular crisis group（n=172）. The independent risk factors of postoperative vascular crisis were analyzed by logistic regression analysis. The other 220 patients who underwent replantation of amputated finger were selected as the study subjects and divided into conventional analgesia group and preemptive analgesia group（preemptive analgesia of fentanyl transdermal patch） according to the order of operation， with 110 cases in each group. The postoperative pain and comfort was assessed. The survival rate and function of replanted finger at 6 months after replantation was observed. Results ①Logistics regression analysis showed that gender， age， smoking history， ischemic time， trauma type and segmental plane were independent risk factors of vascular crisis （P 　　[Key words] Replantation of amputated finger； Vascular crisis； Fentanyl transdermal patch； Preemptive analgesia 　　随着显微外科技术的不断进步，临床断指再植术成功率已得到较大幅度的提高[1]，