摘要
目的观察肌间沟臂丛神经自控镇痛(PCRA)对肱骨髁骨折手术患者围手术期应激反应、镇痛效果的影响。方法 20例(ASAⅠ～Ⅱ级)肱骨髁骨折患者在肌间沟臂丛麻醉下术后随机分为两组。治疗组采用PCRA法,镇痛药0.75%罗哌卡因30mL+芬太尼0.7mg,外周神经刺激器引导下肌间沟臂丛神经鞘穿刺置管接术后患者自控镇痛(PCA)镇痛泵,按锁定加压钢板(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15分钟;对照组采用PCIA法,镇痛药芬太尼0.7mg+氯偌昔康32mg,静脉穿刺置管接PCA镇痛泵,模式同治疗组。测定麻醉前、术后24小时和48小时皮质醇、血管紧张素Ⅱ和血糖的血浆浓度及收缩压(SBP)、舒张压(DBP)、心率(HR)的变化,同时记录VAS疼痛评分、满意度评分,术后24小时和48小时肘关节活动度情况。结果治疗组与对照组术后24小时、48小时与麻醉前比较,SBP、DBP、HR显著降低(P<0.05),VAS疼痛评分及满意度评分治疗组差异有非常显著性(P<0.01),对照组差异有显著性(P<0.05),皮质醇、血管紧张素Ⅱ、血糖的水平差异有显著性(P<0.05)。治疗组与对照组术后24小时、48小时比较,SBP、DBP、HR无明显差异(P>0.05),VAS疼痛评分及满意度评分差异均有显著性(P<0.05),皮质醇、血管紧张素Ⅱ、血糖的水平差异无显著性(P>0.05),肘关节伸、屈运动度差异均有显著性(P<0.05)。结论 PCRA能有效降低肱骨髁术后患者皮质醇、血管紧张素Ⅱ和血糖的血浆浓度等应激指标,在镇痛效果、患者舒适度、满意度及肘关节活动度方面,较PCIA更具优势。
Objective To observe the interscalene brachial plexus analgesia（PCRA） of humeral condylar fracture surgery patients perioperative stress response,analgesic effect.Methods 20 patients（ASA Ⅰ ~ Ⅱ grade） humeral condylar fractures in patients with interscalene brachial plexus anesthesia were randomly divided into two groups.Treatment group PCRA method analgesic 0.75% ropivacaine 30mL＋ fentanyl 0.7mg,peripheral nerve stimulator-guided interscalene brachial plexus sheath cannulation then PCA analgesia pump,mode of delivery according to LCP,the load（5mL） ＋ continuous volume（2mL/h） ＋ PCA dose（0.5mL / times）,lockout time 15min;control group PCIA method,chlorine analgesic fentanyl 0.7mg ＋ Ruo Xi Kang 32mg,venipuncture PCA pain pump catheter access,model with treatment group.Measured before anesthesia,after 24h and 48h of cortisol,angiotensin Ⅱ and plasma glucose concentrations and SBP,DBP,HR changes were recorded VAS pain scores,satisfaction scores,24h and 48h after the situation elbow activity.Results The treatment group and control group after 24h,48h and before anesthesia compared,SBP,DBP,HR decreased significantly（P0.05）,VAS pain scores and satisfaction scores in treatment group there was a significant difference（P0.01）,control There was a significant difference between groups（P0.05）,cortisol,angiotensin Ⅱ,blood sugar levels significantly（P0.05）.Treatment group and control group after 24h,48h between two groups,SBP,DBP,HR was no significant difference（P0.05）,VAS pain score and satisfaction score were significantly different（P0.05）,Cortisol,Angiotensin II,blood glucose levels were not significantly different（P 0.05）,elbow extension,flexion were significantly different degrees（P0.05）.Conclusion PCRA can effectively reduce postoperative humerus cortisol,angiotensin Ⅱ and plasma concentrations of glucose and other stress indicators,analgesia,patient comfort,satisfaction and aspects of the elbow joint activity,more than PCIA advantage.
出处
《辽宁医学杂志》
2011年第2期60-63,共4页
Medical Journal of Liaoning
