自控镇静对断指再植患者血管危象发生率的影响

目的 研究自控镇静（PCS）对断指再植术后血管危象发生率的影响.方法 本组232例断指再植患者,随机分为P组（n=130）与C组（n=102）.两组均采用连续腋路臂丛麻醉,术后行腋路臂丛阻滞镇痛.P组术后以咪唑安定复合芬太尼行PCS,C组术后给予心理护理,必要时应用镇静剂,两组镇痛镇静时间均为72 h.观察患者镇痛（VAS）镇静（Ramsay）评分、焦虑评分（SAS）、再植指血管危象发生及成活情况、PCS期间生命体征及不良反应发生情况.结果 P组术后各时间点的Ramsay评分均高于C组（P＜0.01）,镇静不足病例P组明显少于C组;两组VAS评分差异无显著性；SAS评分P组明显低于C组（P＜0.01）,焦虑发生率P组明显低于C组（P＜0.01）；P组血管危象发生率明显低于C组（P＜0.05）；两组PCS期间生命体征均平稳,无恶心、呕吐、低血压、呼吸抑制等不良反应发生.结论 PCS能够为断指再植患者术后提供安全有效的镇静治疗,从而降低血管危象的发生率.

The influence of patient-controlled sedation on vascular crisis incidence in replanlation of amputated finger

Objective To explore influence of patient-controlled sedation（PCS） on vascular crisis incidence in replanlation of amputated finger. Methands 232 patients with replanlation of amputated finger were randomly divided into patient-controlled sedation group （P group,n=130） and control group（C group,n= 102）, both of groups with continuous axillary brachial plexus anaesthesia by catheter which inserted after operation, P group were given midazolam and fentany for PCS, C group were given psychological instruction,comfort and sedative if necessary, the times of both analgesia and mitigate were 72 hours. Observe scores of analgesia （VAS）, mitigate （Ramsay）, anxiety （SAS） and Vascular crisis, survival of replanlation of amputated finger. Results Ramsay scores of each time point in P group were higher than C group （P〈0.01）, there was no significant difference of VAS between two groups; the scores of SAS were obviously higher than C groop （P〈0.01）, 20 cases in C group were slight or moderate anxiety, and no anxiety in P group, it was obviously difference between two groups （P〈0.01）; vascular crisis in P groop were obviously fewer than P group （P〈0.01）. Conclusion PCS can obviously reduce vascular crisis incidence, and increase survival rate with replanlation of amputated finger.