摘要:
Objective To explore the clinical effect of propacetamol and dezocine for the prevention and treatment of vascular crisis in the preemptive analgesia after digit replantation.Methods 85 cases of patients treated with digit replantation were selected for the study and divided into the propacetamol group (n =45) and the dezocine group (n =40) according to the different postoperative preemptive analgesic method.The two groups were given with propacetamol or dezocine and fentanyl and ondansetron patient-controlled intravenous analgesia (PCIA) respectively.The analgesic and sedative effects were observed between the two groups,and the occurrence of vascular embolism and vascular crisis and the survival rate of rcplantation were counted.Results There was no significant difference between the two groups in the visual analogue pain score (VAS) at 3 hours after operation (P <0.05).The VAS scores of the two groups were significantly increased at 6 h and 24 h after operation while the VAS score was significantly decreased at 48 h after operation (P < 0.05),and the VAS scores were significantly lower in the propacetamol group than those in the dezocine group at 6 h,24h and 48 h after operation (P < 0.05).The difference of the Ramsay sedation scores distribution at 3 hours after operation was statistically significant between the two groups (P < 0.05),and the sedative effect was more satisfactory in the propacetamol group.Within 48 h after operation,PCI effective times/actual sub values of the propacetamol group were significantly higher than the dezocine group (P <0.05).The incidence rates of postoperative vascular thrombosis and arterial or venous crisis were 4.44%,6.67% and 6.67% respectively in the propacetamol group,which were significantly lower than those in the dezocine group with 20.00%,22.50% and 27.50% (P < 0.05).The survival rate of digit replantation,digit replantation at 6 months after treatment were 97.78%,85.00% which was higher than that of the dezocine group with 91.11%,75.00% (P < 0.05).Conclusions Compared with dezocine,propacetamol can attain the ideal analgesic and sedative effects and improve the survival rate of replantation,which has a significant role in the prevention and treatment of vascular crisis in the adjuvant treatment of postoperative analgesia in digit replantation.%目的 探讨丙帕他莫和地佐辛用于断指再植术后超前镇痛防治血管危象的临床效果.方法 85例行断指再植术患者根据术后超前镇痛方法的不同分为丙帕他莫组(45例)和地佐辛组(40例),分别给予丙帕他莫、地佐辛静脉自控镇痛(PCIA),比较两组镇痛及镇静效果,血管栓塞、血管危象发生情况及断指再植存活率.结果 两组术后3h视觉模拟疼痛评分(VAS)比较差异无统计学意义(P<0.05),两组术后6、24 h VAS评分有明显升高的趋势,术后48 h VAS评分明显回落(P<0.05),而丙帕他莫组术后6、24、48 h VAS评分均显著低于地佐辛组(P<0.05).两组术后3 h Ram-say镇静评分分布比较差异有统计学意义(P<0.05),且丙帕他莫组术后48 h内PCI有效次数/实际次数值均显著高于地佐辛组(P<0.05).丙帕他莫组术后血管栓塞及动脉、静脉血管危象发生率分别为4.44%、6.67%、6.67%,明显低于地佐辛组的20.00%、22.50%、27.50% (P<0.05).丙帕他莫组断指再植存活率、术后6个月断指再植功能优良率(97.78%、91.11%)明显高于地佐辛组(91.11%、75.00%,P<0.05).结论 与地佐辛相比,丙帕他莫辅助断指再植术术后镇痛,可发挥理想的镇痛镇静效果,提高再植指存活率,并对防治血管危象有显著作用.