罂粟碱对断指再植患者血浆降钙素基因相关肽和内皮素的影响

发布时间：2018-11-21 16:43

【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(P0.05);B组在T1时血浆CGRP水平较D组升高,而ET水平较D组下降(P0.05)。A组:T1、T2、T3、T4、T5与T0比较血浆CGRP水平升高,而ET水平下降(P0.05);B组:T1与T0比较血浆CGRP水平升高,而ET水平下降(P0.05)。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。
[Abstract]:Objective to compare the effects of axillary brachial plexus block by intramuscular injection of papaverine and bupivacaine on plasma calcitonin gene-related peptide (CGRP) and endothelin (et) in patients with replantation of severed fingers. Methods 120 patients who needed replantation of severed fingers were divided into 4 groups by random digital table: group A, B, C as observation group. Group D was treated with 0.25% bupivacaine hydrochloride 1.5 mg/kg, volume (40.2 卤2.9) m L) for axillary brachial plexus block (guided by nerve stimulator). In group C, 0.0625 mg/m L papaverine (0.0375 mg/kg) was added into local anesthetic solution, intravenously and intramuscularly. The patients in group C were treated before brachial plexus block (T0) and 0.5 h (T1) after brachial plexus block, respectively. Venous blood was drawn from 1 h (T 2), 2 h (T 3), 4 h (T 4), 8 h (T 5), 12 h (T 6). The plasma levels of calcitonin gene-related peptide (calcitonin gene-related peptide,CGRP) and endothelin (endothelin,ET) were measured by radioimmunoassay. The incidence of vascular crisis and the survival rate of finger replantation were recorded 1 week after operation. Results the plasma CGRP level in group A was higher than that in group D, while the level of ET in group A was lower than that in group D (P0.05). The plasma CGRP level in group B was higher than that in group D at T1, while the level of ET in group B was lower than that in group D (P0.05). A group: the level of plasma CGRP was higher than that of T0 group (P0.05); the level of ET in group B was lower than that in group T0 (P0.05). Group B: compared with T0, the level of plasma CGRP increased and the level of ET decreased (P0.05) in group B (P0.05) there was no vascular crisis in the patients of). A group, and all the replanted fingers survived, while in group D, there were 23 cases of vascular crisis in group D, with 1 vessel crisis, 2 cases in group C, and 2 cases in group D, respectively. There were 2 cases of finger necrosis after replantation. Conclusion compared with other methods, intraaxillary brachial plexus block anesthesia with papaverine and bupivacaine in local anesthetic solution can increase the level of plasma CGRP, in patients with severed finger replantation and reduce the incidence of vascular crisis in patients with amputated finger replantation. Improve the survival rate of amputated fingers.
【作者单位】：潍坊医学院麻醉系;解放军第401医院手外麻醉科;
【基金】：济南军区后勤科研基金(CJN09L068)~~
【分类号】：R614

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