臂丛神经自控镇痛在肩锁关节手术后的应用.docVIP

臂丛神经自控镇痛在肩锁关节手术后的应用 许忠玲 张德祥 朱 翔 周 媛 祝文彩 226001 南通大学附属医院麻醉科 【摘要】目 的 研究臂丛神经自控镇痛（PCRA）对围术期肩锁关节骨折脱位手术患者应激反应的影响及镇痛治疗优势的探讨。方 法 20例（ASAⅠ～Ⅱ级）肩锁关节骨折脱位患者在臂丛麻醉下手术后随机分为二组，R组（n=10）：采用PCRA法，镇痛药0.1125%左旋布比卡因+0.0003%芬太尼+0.01%地塞米松，臂丛神经鞘穿刺置管接PCA镇痛泵，按LCP模式给药，即负荷量（5ml）+持续量（2ml/h）+PCA剂量（0.5ml/次），锁定时间15min；I组（n=10）：采用PCIA法，镇痛药0.001%芬太尼+0.01%地塞米松，静脉穿刺置管接PCA镇痛泵，模式同R组。测定麻醉前、术后24h和48h皮质醇、血管紧张素Ⅱ和血糖的血浆浓度及SBP、DBP、HR的变化，同时记录VAS疼痛评分、满意度评分，术后24h和48h肩锁关节活动度情况。结 果 R组与I组术后24h、48h与麻醉前比较， SBP、DBP、HR显著降低(P0.05)，VAS疼痛评分及满意度评分R组有非常显著性差异(P0.01)，I组有显著性差异(P0.05)，皮质醇、血管紧张素Ⅱ、血糖的水平有显著性差异(P0.05)。R组与I组术后24h、48h两组间比较，SBP、DBP、HR无明显差异(P0.05) ，VAS疼痛评分及满意度评分均有显著性差异(P0.05)，皮质醇、血管紧张素Ⅱ、血糖的水平无显著性差异(P0.05)，肩外展上举、肩前屈上举、肩后伸均有显著性差异（P0.05）。.结 论 PCRA能有效地降低肩锁关节术后患者皮质醇、血管紧张素Ⅱ和血糖的血浆浓度等应激指标，镇痛效果、病人舒适度、满意度及肩锁关节活动度，PCRA更具优势。 【关健词】围术期 臂丛神经自控镇痛（PCRA） 静脉自控镇痛（PCIA） 左旋布比卡因 Effects of three different analgesic methods on the perioperative upper extremety patients XU zhongling , Zhang dexiang, Zhuxiang Zhouyuan Zhu wencai Department of Anesthesiology,Affiliated Hospital of Nantong Medical College,Nantong226001 Abstract Objective: The aim of this study is to evaluate the effects of three different analgesic methods on the perioperative upper extremety patients. Materials and Methods: Thirty cases of the upper extremety disease were divided into 3 groups randomly; each group was given the following analgesic method respectively: the control group (when necessary, giving analgesics), the PCRA group, and the PCIA group. The plasma concentrations of the cortisteroid, the angiotensin II and the blood glucose were collected at he different following stages: before anesthesia, 8 hours after operation, 24 hours after operation and 48 hours after operation. Meanwhile, the changes of SBP, DBP, HR and SpO2 were evaluated by the VAS criteria, the results from which were recorded, and the side effects were also recorded. Results: The 3 plasma concentrations showed the same changes in the PCRA and PCIA groups, whose percentages were significan