摘要
目的观察低分子右旋糖酐联合阿司匹林治疗断指的效果及对血小板动力型指数(TPI)、D-二聚体水平的影响。方法前瞻性将2019年2月至2022年3月四川现代医院收治的195例断指再植患者为研究对象,采用简单随机法分为对照组97例和观察组98例。两组均接受断指再植术,对照组给予低分子右旋糖酐静滴治疗,观察组在对照组基础上给予阿司匹林治疗。比较两组术后疼痛程度及并发症情况。检测两组术后1、7 d时再植部位超声检查结果、血液流变学指标、TPI、D-二聚体的差异。结果观察组术后1、3、5、7 d时疼痛程度评分均低于对照组,差异均有统计学意义(P<0.05)。术后1 d,两组再植部位超声检查结果比较,差异均无统计学意义(P>0.05);术后7 d,两组平均血流速(Vm)、血管管径明显高于术后1 d,血流阻力指数(RI)、动脉搏动指数(PI)明显低于术后1 d,观察组术后7 d Vm、血管管径为(7.42±0.52)cm/s、(1.05±0.03)mm,明显高于对照组[(5.32±0.47)cm/s、(0.77±0.02)mm],RI、PI分别为0.67±0.04、1.75±0.14,明显低于对照组(0.79±0.05、2.08±0.16),差异均有统计学意义(P<0.05)。术后1 d,两组血液流变学指标、TPI、D-二聚体比较,差异均无统计学意义(P>0.05);术后7 d,两组全血高切黏度、血浆黏度明显低于术后1 d,对照组TPI、D-二聚体明显高于术后1 d,观察组TPI、D-二聚体与术后1 d比较,差异均无统计学意义(P>0.05);观察组术后7 d全血高切黏度、血浆黏度、TPI、D-二聚体为(6.33±0.78)mPa·s、(1.51±0.19)mPa·s、(10.97±2.04)、(0.36±0.14)mg/L,均低于对照组[(7.12±0.92)mPa·s、(1.63±0.23)mPa·s、(13.89±2.41)、(0.45±0.16)mg/L],差异均有统计学意义(P<0.05)。观察组血管危象发生率和总并发症率均低于对照组,差异均有统计学意义(P<0.05),而切口感染、皮下血肿、皮瓣坏死发生率与对照组比较,差异无统计学意义(P>0.05)。结论低分子右旋糖酐联合阿司匹林可减轻断指再植术后患者疼痛感,促进指体血运恢复,预防血管危象的发生。
Objective To observe the effect of low molecular weight dextran combined with aspirin in the treatment of severed fingers and the effect on thrombodynamic potential index(TPI)and D-dimer level.Methods A total of 195 patients with severed finger replantation who were admitted to Sichuan Modern Hospital from February 2019 to March 2022 were selected as the subjects,and were divided into a control group with 97 cases and an observation group with 98 cases by a simple random method.Both groups received replantation of severed fingers,the control group was given low-molecular-weight dextran intravenously,and the observation group was given aspirin on the basis of the control group.The postoperative pain degree and complications were compared between the two groups.The differences in ultrasound examination results,hemorheological indexes,TPI and D-dimer of the replantation site were detected at 1 day and 7 days after operation between the two groups.Results The pain severity scores of the observation group at 1,3,5,and 7 days after operation were lower than those of the control group,the differences were statistically significant(P<0.05).At 1 day after operation,there was no statistically difference in the ultrasound examination results of the replantation site between the two groups(P>0.05).At 7 days after the operation,the average blood flow rate(Vm)and vessel diameter of the two groups were significantly higher than those 1 day after operation,and the blood flow resistance index(RI)and arterial pulsatility index(PI)were significantly lower than 1 day after operation,and the Vm and vessel diameter of the observation group were(7.42±0.52)cm/s and(1.05±0.03)mm at 7 days after operation,which were significantly higher than those of the control group[(5.32±0.47)cm/s and(0.77±0.02)mm],RI and PI were 0.67±0.04 and 1.75±0.14,which were significantly lower than those of the control group(0.79±0.05 and 2.08±0.16),and the differences were statistically significant(P<0.05).At 1 day after operation,there was no statistically difference in hemorheology indexes,TPI and D-dimer between the two groups(P>0.05).The TPI and D-dimer in the control group were significantly higher than those on the 1st postoperative day,and there was no statistically difference in TPI and D-dimer in the observation group compared with that on the 1st postoperative day(P>0.05).The whole blood high shear viscosity,plasma viscosity,TPI and D-dimer in the observation group at 7 days after operation were(6.33±0.78)mPa·s,(1.51±0.19)mPa·s,(10.97±2.04),(0.36±0.14)mg/L,which were lower than those in the control group[(7.12±0.92)mPa·s,(1.63±0.23)mPa·s,(13.89±2.41),(0.45±0.16)mg/L],and the differences were statistically significant(P<0.05).The incidence of vascular crisis and total complications in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05),and there was no statistically difference in the incidence of incision infection,subcutaneous hematoma,and skin flap necrosis compared with the control group(P>0.05).Conclusion Low-molecular-weight dextran combined with aspirin can relieve pain in patients after replantation of severed fingers,promote the recovery of blood circulation in the fingers,and prevent the occurrence of vascular crisis.
作者
汤发艳
周绍勇
TANG Fa-yan;ZHOU Shao-yong(Department of Clinical Laboratory,Sichuan Modern Hospital,Chengdu Sichuan 610041,China;Department of Hand Surgery,Sichuan Modern Hospital,Chengdu Sichuan 610041,China)
出处
《临床和实验医学杂志》
2023年第5期543-546,共4页
Journal of Clinical and Experimental Medicine
基金
四川省卫生计生委科研项目(编号:17PJ526)
2021年成都市医学科研课题(编号:2021184)。
关键词
低分子右旋糖酐
阿司匹林
断指再植
血管危象
Low molecular weight dextran
Aspirin
Finger replantation
Vascular crisis
