右美托咪定辅助术后镇痛对断指再植成活率的影响
发表时间：2014-07-01 浏览次数：945次
张颖，张立，张文龙.右美托咪定辅助术后镇痛对断指再植成活率的影响[J].中华整形外科杂志.2014, 30(3):187-191.
右美托咪定;断指再植术;白控镇痛泵
张颖，张立，张文龙
063000,河北省唐山市第二医院麻醉科
2014
187-191
知网,万方
目的 观察右美托咪定辅助术后镇痛对断指再植术再植指成活率的影响.方法 选择符合一定条件的拟行断指再植术者共91例,按随机数字表法排列分为右美托咪定组(A组,48例)和对照组(B组,43例)2组.术毕开启白控静脉镇痛泵(patient controlled intravenous analgesia,PCIA),A组药物:芬太尼1.0mg+托烷司琼4.0 mg+地佐辛10 mg+右美托咪定200 μg+生理盐水稀释至100 ml,B组除不加右美托咪定外,其他药物同A组.镇痛泵持续输注量2 ml/h,单次给药量0.5 ml,锁定时间15 min.分别记录并统计术后0～6h、6～12h、12～24 h和24 ～ 48 h的VAS评分、Ramsay评分、再植指情况、不良反应等.结果 2组患者间年龄、性别、身高、体重、受伤至手术开始时间(Ts)、受伤至通血成功时间(Tt),差异无统计学意义(P＞0.05).2组患者术后0～6h、6～12h、12 ～ 24 h和24 ～48 h,VAS评分差异有统计学意义(P＜0.05),Ramsay评分差异无统计学意义(P＞0.05).2组患者术后最高VAS评分和最低Ramsay评分,差异均有统计学意义(P＜0.05).A组患者60指有3指发生血管危象,2指行血管探查术,B组患者56指有1 3指发生血管危象,10指行血管探查术,差异有统计学意义(P＜0.05).2组PCIA不良反应比较,差异无统计学意义(P＞0.05),2组患者也均未发生心动过缓和低血压.手术4周后A组有58指存活,存活率96.7％(58/60);B组47指存活,存活率83.9％ (47/56),差异有统计学意义(P＜0.05).结论 右美托咪定辅助术后镇痛,可提高断指再植术后再植指的成活率,并具有安全性. Objective To observe the effect of postoperative analgesia with dexmedetomidine on the survival rate of amputated finger replantation.Methods 91 cases,who was going to receive amputated finger replantation,were randomly divided into group A (n =48) and B (n =43).PCIA (patient-controlled intravenous analgesia) was set immediately after operation in group A(fentanyl 1.0 mg + tropisetron 4.0 mg + 10 mg + dexmedetomidine 200 μg + saline 100 ml) and group B (same as group A except dexmedetomidine).Background infusion is 2 ml/h with a bolous of 0.5 ml and lockout time is 15 min.postoperative VAS score,Ramsay score,condition of replanted fingers and other adverse events at the 0-6 h,6-12 h,12-24 h and 24-48 h were recorded and analyzed.Results The age,sex,height,weight,amputated time (Ts),revascularized time (Tt) in the two groups were not statistically different (P ＞ 0.05).Postoperative VAS score in the two groups was significantly different at the 0-6 h,6-12 h,12-24 h and 24-48 h (P ＜ 0.05),but Ramsay score was not (P ＞ 0.05).The highest and lowest postoperative VAS score and Ramsay score were markedly different between two groups (P ＜ 0.05).3 of the 60 fingers in group A experienced vascular crisis and 2 underwent vascular explore surgery.13 of 56 fingers in group B occurred vascular crisis,and 10 underwent vascular explore surgery,showing significant difference between the two groups(P ＜0.05).PCIA adverse reactions showed no difference between the two groups (P ＞ 0.05).Bradycardia and hypotension didn' t happen in any patients in the two groups.4 weeks after surgery,the survival rate was 96.7％ (58/60) in group A,and 83.9％ (47/56) in group B (P ＜0.05).Conclusion Postoperative analgesia with dexmedetomidine as an adjuvant can increase the survival rate of replantation fingers with high safety.
