摘要
背景:不同麻醉和镇痛方法应用于上肢再植术各有优缺点,麻醉效果、生理功能的干扰和对疾病转归的影响是主要评价指标。目的:探讨微量泵持续输注低浓度罗哌卡因硬膜外麻醉用于上肢(掌、指)再植术的临床效果及安全性。设计、时间及地点:自身前后对照观察,于2006-06/2008-06在石河子大学医学院第一附属医院麻醉科完成。对象:石河子大学医学院第一附属医院27例行急诊断肢(掌、指)再植手术的患者27例,男19例,女8例;年龄26～53岁,均符合美国麻醉医师协会(ASA)分级标准Ⅰ～Ⅱ级,且对麻醉和术后镇痛方法知情同意。药物配方:10g/L罗哌卡因20mL+生理盐水40mL,即得3.3g/L罗哌卡因麻醉药液60mL。方法:全组采用颈部硬膜外麻醉。先同时按压∑键和FAST键快速输注8.0～10.0mL,继而设定5～7mL/h的速度恒速输注。每隔5min以针刺法测定麻醉平面,直至达到手术要求开始手术。术中每隔1.0～2.0h,静脉注射咪唑安定1.0～2.0mg清醒镇静。术毕更换2g/L罗哌卡因镇痛液,4～6mL/h速度持续输注术后镇痛两三天。主要观察指标:术中监测心电图、血压、心率、呼吸频率、脉搏氧饱和度,并记录麻醉起效时间、镇痛效果、麻醉平面和运动神经阻滞程度;术后镇痛评分、48h血压下降、呼吸抑制、恶心呕吐、尿潴留、皮肤瘙痒等不良事件发生率。结果:27例患者全部进入结果分析。①27例患者均取得满意麻醉效果;目测类比评分0分88.9%,1分7.4%,2分3.7%;麻醉起效时间(15.2±4.3)min;运动神经阻滞轻微,能配合手术要求,术中安静不动。②血压、心率持续输注期间波动轻微;脉搏氧饱和度(98±2)%,高于术前。呼吸频率(16.5±3.6)次/min,较术前缓慢。③术后镇痛效果满意率92.6%。结论:①微量泵持续输注3.3g/L罗哌卡因硬膜外麻醉可以安全用于上肢(掌、指)再植术,麻醉效果满意,特别适用于手术时间冗长的复杂再植术。②2g/L罗哌卡因持续输注便于术后镇痛,镇痛效果确切,不良事件发生率低。
BACKGROUND： Different anesthesia and analgesia applied in upper limb replantation has its advantages and disadvantages. The anaesthetic effect, interference and influence to physiological function of the main disease outcome served as evaluation index. OBJECTIVE： To investigate the efficacy and safety of epidural anesthesia of low concentration ropivacaine infused continuously by microinfusion pump in upper limb replantation. DESIGN, TIME AND SE＇I-rlNG： A before-after controlled observation was performed at the Department of Anesthesiology, First Affiliated Hospital, Medical College of Shihezi University from June 2006 to June 2008. PARTICIPANTS： Twenty-severn patients underwent emergency upper limbs replantation （ Ⅰ- Ⅱ grade by American Society of Anesthesiologists） in the First Affiliated Hospital, Medical College of Shihezi University From June 2006 to June 2008, including 19 males and 8 females, aged 26-53 years. Informed consent was obtained from each patient. Drug formula： 10 g/L ropivacaine 20 mL preparation added 40 mL physiological saline to got 3.3 g/L ropivacaine 60 mL. METHODS： All patients were administered by cervical epidural anesthesia. First, simultaneously pressed ∑ and FAST buttons to set for rapid infused 8-10 mL, and then set infusion with 5-7 mL/h constant speed. The coverage of anesthesia was measured every 5 minutes until to meet the demands of the surgery. Midazolam 1-2 mg as conscious sedation was intravenous injected each 1-2 hour in the operation. Replaced analgesia fluid to 0.2% ropivacaine 4-6 mL/h continuous infused as postoperative analgesia for 2 3 days after the operation. MAIN OUTCOME MEASURES： The electrocardiogram （ECG）, blood pressure （BP）, heart rate （HR）, breathing frequency （DR）, and pulse oxygen saturation （SpO2） was monitored in the operation; the anesthesia effect-acting period, analgesia effect, block anesthesia plane and blockage of motor nerves was recorded. In addition, visual analogue scale （VAS） scores of analgesia, the rate of adverse events incidence, such as the blood pressure drops, respiratory inhibition, nausea and vomiting, urinary retention and itchy of skin was measured. RESULTS： Totally 27 patients were involved in the final analysis. （1）Twenty-seven patients achieved satisfactory anesthesia effect, the VAS 0 score was 88.9%, 1 score was 7.4%, 2 scores was 3.7%; Anesthesia effect-acting period was （15.2±4.3） minutes, motor nerve was slightly blocked, all patients could cooperate with the demands of the surgery, and keep quiet. （2）During continuous infusion, the BP, HR were slightly fluctuated, SpO2 was （98±2）%, which was higher than before operation. BR was （16.5±3.6） time per minute, which was lower than that of preoperative. （3）Postoperative analgesia satisfaction was 92.6%. CONCLUSION： （1）Continuous infusion 3.3 g/L ropivacaine by the microinfusion pump in epidural anesthesia can be safely used in upper limbs replantation, especially suitable for long time complicated replantation operation. （2）Continuous infusion 2 g/L ropivacaine is convenient for postoperative analgesia, which can obtain excellent analgesic effects with low incidence of adverse events.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2009年第31期6067-6070,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
