连续臂丛神经阻滞镇痛对断指再植术后缺血再灌注损伤影响的研究

目的研究连续臂丛神经阻滞镇痛对断指再植术后缺血再灌注损伤的影响,并探讨其发生的可能机制。方法将60例急诊行断指再植术患者随机分为术后自控性臂丛神经阻滞镇痛组(CA组)和对照组(NA组),每组30例。观察两组再植指术后血管痉挛、血管栓塞和指体坏死发生例数并计算再植指成活率,记录两组术前(T0)、术后3h(T1)、术后24h(T2)、术后48h(T3)时患侧肘静脉血丙二醛(MDA)和超氧化物歧化酶(SOD)浓度。结果断指再植术后成活率CA组高于NA组,差异有统计学意义(χ2=1.66,P<0.05);血管痉挛、血管栓塞和指体坏死发生例数CA组均低于NA组,差异有统计学意义(χ2分别=3.60、1.67、1.66,P均<0.05)。两组不同时间点间MDA、SOD比较,差异均有统计学意义(F分别=29.43、59.82、15.51、27.53,P均<0.05)。与T0点比较,两组在T1、T2、T3时间点MDA均增高,SOD均降低,差异均有统计学意义(t分别=15.24、13.02、13.48、8.68、14.87、24.42;23.60、17.22、14.63、7.83、12.70、17.71,P均<0.05)。在T1、T2、T3时间点,CA组MDA均低于NA组,SOD均高于NA组,差异均有统计学意义(t分别=2.51、2.26、2.24;2.82、3.04、2.77,P均<0.05)。结论患者自控性连续臂丛神经阻滞镇痛对缺血再灌注的再植指具有保护作用,提高了断指再植的成功率。

Effect of continuous brachial plexus nerve block analgesia on ischemia-reperfusion injury after finger replantation

Objective To observe the effect of continuous armpit road method brachial plexus nerve block analgesia on ischemia-reperfusion injury after finger replantation and the possible mechanism. Methods Sixty cases undergoing finger replantation were randomly divided into the control of brachial plexus nerve block analgesia group（CA group） and the con- trol group （NA group）. Vasospasm, Vascular embolization and body necrosis occurred number, survival rate of replantation were observed. Recorded two groups respectively on preoperative （To）, postoperative 3 hours （TI）, postoperative 24 hours （T2）, postoperative 48 hours（T3） with side cubits venous blood malondialdehyde （MDA） and superoxide dismutase（SOD） concentration. Results The replantation finger survival rate of CA group was higher than that of the NA group, the differ- ence was statistically significant（x2= 1.66 ,P〈O.05）. Vascular spasm, vascular embolization and body necrosis occurred in CA group were lower than those of NA group. The differences were statistically significant （X2=3.60,1.67,1.66,P〈0.05）. Compared with To point, two groups in T1, T2, T3 time points, MDA were increased, SOD were reduced. The differences were statistically significant （t =15.24,13.02,13.48,8.68,14.87,24.42; 23.60,17.22,14.63,7.83,12.70,17.71,P〈0.05）. In the T1, T2, T3 time point, MDA of CA group were lower than those of the NA group, SOD of CA group were higher than those of the NA group. The differences were statistically significant （t=2.51,2.26,2.24;2.82,3.04,2.77,P〈O.05）. Conclusions Self-control continuous brachial plexus nerve block analgesia has protective function on ischemia-reperfu- sion after renlantation, and could imnrove the success rate of renlantation.