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目的 观察连续臂丛神经阻滞术后患者自控镇痛(PCA)对再植断指成活的影响.方法 断指再植手术患者42例(60指)随机均分为两组:NPCA组采用连续臂丛神经阻滞PCA,镇痛药配方为1.0％罗哌卡因20 ml+舒芬太尼100μg+右美托咪定200μg+托烷司琼5 mg+生理盐水至100 ml;IPCA组采用静脉PCA,镇痛药配方为氟哌利多2.5 mg+舒芬太尼100μg+右美托咪定200 μg+托烷司琼5 mg+生理盐水至100 ml.镇痛泵参数:背景输注量2 ml/h,PCA单次追加量0.5ml,锁定时间15 min.评估术前、术后12h、24 h和48 h的VAS疼痛评分.记录再植指的血运状况.测定术前和术后第1、2、3天血浆内皮素1(ET-1).统计再植断指成活率.结果 NPCA组术后VAS疼痛评分均低于IPCA组(P＜0.05).与IPCA组比较,NPCA组再植指毛细血管充盈时间短、SpO2高、温度差小、血浆ET-1水平低(P＜0.05).NPCA再植指成活率100％,高于IPCA组的81％(P＜0.05).结论 在断指再植手术患者,连续臂丛神经阻滞PCA较静脉PCA镇痛效果好,再植指成活率高.“,”Objective To observe the effect of postoperative patient-controlled analgesia(PCA) with continuous brachial plexus nerve block on the survival of replantation of severed fingers.Methods Postoperative PCA was performed in 42 patients underwent the replantation of severed fingers,who were equally randomized into two groups with 30 severed fingers each.The patients in group NPCA were given postoperative analgesia with continuous brachial plexus nerve block,in which the analgesic solution consisted of 1.0％ ropivacaine 20 ml,sufentanil 100 μg,dexmedetomidine 200 μg and tropisetron 5 mg in normal saline 100 ml.The patients in group IPCA were given postoperative intravenous PCA with droperidol 2.5 mg,sufentanil 100 μg,dexrnedetomidine 200 μg and tropisetron 5 mg in normal saline 100 ml.The analgesic variables for both groups were set up as a background infusion of 2 ml/h and a bolus dose of 0.5 ml in a lockout interval of 15 minutes.The VAS pain scores were evaluated before and at 12,24 and 48 hours after surgery.The patency of blood flow was observed.Plasma endothelin 1 (ET-1) was measured before and on the 1st,2nd and 3rd day after operation.The survival rate of replated fingers was calculated.Results The VAS pain scores during PCA were lower in group NPCA than those in group IPCA(P＜0.05).Compared to group IPCA,the replanted fingers in group NPCA had shorter capillary filling time,less difference of skin temperature and higher SpO2 (P＜0.05).Plasma levels of ET-1 after operation were lower in group NPCA than those in group IPCA(P＜0.05).The survival rate of replanted finger was higher in group NPCA than that in group IPCA(100 ％ vs.81％) (P＜0.05).Conclusion In the patients undergoing replantation of severed fingers,postoperative PCA with continuous brachial plexus nerve block is better than intravenous PCA in analgesia and in the improvement of the survival rate of replanted fingers.