断指再植患者容积流率及皮肤血流量与寒冷耐受不良的关系

Correlation of volumetric flow rate and skin blood flow with cold intolerance in finger replantation

目的研究断指再植血流量:包括容积流率(volumetric flow rate,VFR)和皮肤血流量(skin blood flow,SkBF)与再植手指的寒冷耐受不良之间的关系。方法回顾分析2011年1月至2014年12月,在我院接受断指再植手术的患者。收集每位患者的手术数据,包括年龄、性别、损伤机制、截指水平、缺血时间、修复的动脉数量以及是否发生血管危象。通过彩色多普勒超声测量动脉血流速度和口径,并计算容积流率(volumetric flow rate,VFR)。通过Laser Speckle Imager测量SkBF,比较分析寒冷不耐受患者和非寒冷耐受不良患者的手术数据和血流数据。还分析了VFR和SkBF之间的相关性。结果 86例纳入本研究,其中39例为寒冷耐受不良。在血管危象中存活的手指中VFR和SkBF较低且寒冷耐受不良发生率较高。差异有统计学意义(P<0.05)。双动脉修复的再植手指VFR较高,但SkBF和寒冷耐受不良的发生率差异无统计学意义(P>0.05)。VFR和SkBF之间也未发现相关性。结论在血管危象中存活的再植手指具有较高的寒冷耐受不良发生率,这与其降低的SkBF和VFR相关,但这种关系在常见的断指再植中不存在。

Objective To evaluate the correlation of volumetric flow rate( VFR) and skin blood flow( SkBF) with cold intolerance in finger replantation. Methods A retrospective study was performed on patients after severed finger replantation from January 2011 to December 2014. Surgical data including age, gender, injury mechanism, amputation, ischema, number of arteries repaired, vascular crisis were collected. Arterial blood flow velocity and caliber were measured by color Doppler ultrasound and the VFR was calculated. The SkBF was measured by the Laser Speckle Imager. A comparative study of surgical data and blood flow were conducted between patients with or without cold intolerance. Correlation between VFR and SkBF were also analyzed. Results A total of 86 patients( 39 patients with cold intolerance) met the inclusion criteria for the study. Lower VFR and SkBF, higher incidence of cold intolerance brought higher survival rate from the vascular crisis with statistical significance( P < 0.05). The VFR of replanted fingers in double arterial repair was higher, but there were no significant differences in the incidence of SkBF and cold intolerance( P > 0.05). No correlation was found between VFR and SkBF. Conclusions Replanted fingers that survived from vascular crisis have a higher incidence of cold intolerance, which is associated with reduced SkBF and VFR. However, this relationship does not exist in common finger replantation.