摘要
目的比较经局部、静脉、肌肉注射罂粟碱配伍布比卡因进行腋路臂丛阻滞对断指再植患者血浆降钙素基因相关肽和内皮素的影响。方法 120例急诊单指离断伤需行断指再植术患者,采用随机数字表法将患者均分4组:A、B、C组为观察组,D组为空白对照组。4组均采用0.25%盐酸布比卡因1.5 mg/kg,容量(40.2±2.9)m L作腋路臂丛神经阻滞(用神经刺激器引导定位)麻醉药物,A、B、C组分别在局麻药液中、静脉滴注中和肌肉注射中加用0.0625 mg/m L罂粟碱(0.0375 mg/kg)。4组患者分别在臂丛阻滞前(T0)和臂丛阻滞后0.5 h(T1)、1 h(T2)、2 h(T3)、4 h(T4)、8 h(T5)、12 h(T6)抽取静脉血,采用放射免疫法检测血浆降钙素基因相关肽(calcitonin gene-related peptide,CGRP)和内皮素(endothelin,ET)的含量,并记录术后1周血管危象发生率及再植指存活率。结果 A组在T1、T2、T3、T4、T5时血浆CGRP水平较D组升高,而ET水平较D组下降(P<0.05);B组在T1时血浆CGRP水平较D组升高,而ET水平较D组下降(P<0.05)。A组:T1、T2、T3、T4、T5与T0比较血浆CGRP水平升高,而ET水平下降(P<0.05);B组:T1与T0比较血浆CGRP水平升高,而ET水平下降(P<0.05)。A组患者没有发生血管危象,再植指全部存活,而B、C、D组患者分别有2、3、6例发生血管危象,分别有1、2、2例再植指坏死。结论局麻药液中罂粟碱配伍布比卡因腋鞘内臂丛阻滞麻醉较其他方式能够在较长时间内升高断指再植患者血浆CGRP,降低ET的含量,可以减少断指再植患者发生血管危象,提高断指的存活率。
Objective To determine the effect of papaverine through topical,intravenous or intramuscular injection combined with bupivacaine for axillary brachial plexus anesthesia on the plasma levels of calcitonin gene-related peptide（ CGRP） and endothelin（ ET） in patients after replantation of amputated fingers. Methods A total of 120 emergency patients with single amputated finger admitted in our hospital from January to December 2014 were randomly divided into 4 groups,groups A,B and C（ observation groups） and group D（ control group）. All patients were given totally 40. 2 ± 2. 9 m L 0. 25% bupivacaine（ 1. 5 mg / kg） for anesthesis in axillary brachial plexus through location of the neural stimulator,and the patients of groups A,B and C were given 0. 062 5 mg / m L papaverine at a dose of 0. 037 5 mg / kg respectively through added in local anesthetic solution,intravenous drop and intramuscular injection. The peripheral venous blood samples in 4groups were taken before anesthesia（ T0） and at 0. 5（ T1）,1（ T2）,2（ T3）,4（ T4）,8（ T5） and 12 h（ T6）after anesthesia. The plasma CGRP and ET concentration were measured by radioimmunoassay. The incidence of vascular crisis and survival rate of replanted finger were recorded after a week. Results The plasma concentration of CGRP was higher in group A than group D at T1,T2,T3,T4 and T5,while that of ET in group A was lower than group D at the same time points（ P〈0. 05）. The level of CGRP was higher in group B than group D at T1,while that of ET was lower in group B than group D at T1（ P〈0. 05）. In the group A,the level of CGRP was higher while that of ET was lower at T1,T2,T3,T4 and T5than at T0（ P〈0. 05）. In the group B,the level of CGRP was higher while that of ET was lower at T1 than at T0（ P〈0. 05）. There was no vascular crisis and all the amputated fingers survived in the group A,while in the groups B,C and D,there were respectively 2,3 and 6 cases having vascular crisis,and respectively 1,2 and 2 cases having necrotic amputated finger. Conclusion Papaverine through local anesthetic solution combined with bupivacaine in axillary brachial plexus anesthesia keeps increasing the plasma level of CGRP and decreasing that of ET compared with treated by other ways within a short time and for quiet a long time,and then reduces vascular crisis and improves the survival rate of replanted finger in patients with amputated fingers.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2015年第13期1357-1361,共5页
Journal of Third Military Medical University
基金
济南军区后勤科研基金(CJN09L068)~~
关键词
罂粟碱
断指再植
血浆降钙素基因相关肽
内皮素
papaverine
replantation of amputated finger
calcitonin gene-related peptide
endothelin
作者简介
[通信作者]张元信，电话：（0532）51870949，E—mail：zhangyuanxin133@163．com
