摘要
目的探讨断指再植术引发血管危象的原因,总结防治心得。方法选择2015年4月至2017年2月在永康市第一人民医院手外科接受断指再植术治疗的患者108例,按照术后血管危象的发生情况分成两组:对照组(56例,未发生血管危险)、观察组(52例,发生了血管危象)。收集整理两组患者的所有临床资料,比较各项资料,分析发生血管危象的原因。观察组患者予低分子右旋糖酐治疗,观察其治疗前后凝血功能指标的变化。结果两组年龄、离断平面、缺血时间分布差异均有统计学意义(均P<0.05),观察组患者接受治疗后的四项凝血功能指标[纤维蛋白酶(3.32±0.29)g/L、活化部分凝血酶时间(27.56±2.08)s、凝血酶时间(12.13±1.62)s、凝血酶原时间(11.47±1.29)s]均有明显的改善(t=4.86、8.63、6.04、4.70,均P<0.05)。结论年龄、离断平面、缺血时间是断指再植术诱发血管危象的主要因素。此外,术后疼痛、患者情绪、体位等多种因素也可能诱发血管危象,做好术前病情的评估,术后加强监测,预防性用药都可防治血管危象。
Objective To explore the causes of vascular crisis caused by replantation of severed finger, and summarize the experience of prevention and treatment. Methods From April 2015 to February 2017, 108 patients with wounded finger treated in the First People's Hospital of Yongkang were divided into two groups according to the occurrence of postoperative vascular crisis situation: the control group (56 cases, vascular risk), the observation group (52 cases, vascular crisis happened). The clinical data of all patients were collected, the various data were compared, and the causes of vascular crisis were analyzed.The observation group was given low molecular dextran treatment, the changes of blood coagulation function indicators before and after treatment were observed. Results The age, disconnection plane, ischemia time had statistically significant differences between the two groups(all P<0.05). After treatment, the four coagulation function index in the observation group [fiber protease:(3.32±0.29)g/L, activated partial thrombin time:(27.56±2.08)s, thrombin time:(12.13±1.62)s, prothrombin time:(11.47±1.29)s] were improved obviously (t=4.86, 8.63, 6.04, 4.70, all P<0.05). ConclusionThe age, disconnection plane and ischemic time are the factors that cause vascular crisis.In addition, postoperative pain, patients' mood, postoperative posture and other factors may also lead to vascular crisis.Preoperative assessment of the condition should be done well, postoperative monitoring should be strengthened, and prophylactic medication can be used to prevent vascular crisis.
作者
陈飞鹏
Chen Feipeng(Department of Hand Surgery,the First People's Hospital of Yongkang,Yongkang,Zhejiang 321300,China)
出处
《中国基层医药》
CAS
2019年第19期2310-2313,共4页
Chinese Journal of Primary Medicine and Pharmacy
基金
浙江省医学会临床科研项目(2013ZYC-A125).
