挤压法治疗断指再植术后静脉危象的实验和临床应用

EXPERIMENT AND CLINICAL APPLICATION OF SQUEEZING TECHNIQUE IN VENOUS CRISIS AFTER REPLANTATION OF FINGER

为探索快速、有力、短时地挤压再植指体对治疗静脉危象的效果，选用２０只ＳＤ鼠，测定在模拟正常、静脉危象和挤压法实施瞬刻三种不同条件下鼠股静脉压。１０只人体离体断指在模拟灌注条件下，测量开放静脉、关闭静脉和关闭静脉并实施挤压三种状态下指背静脉压的变化。结果，ＳＤ鼠上述条件下的股静脉压分别为（８．３３±１．２９）×１０－２ｋＰａ，（２０．６１±２．３４）×１０－２ｋＰａ，（７３．９１±５．７４）×１０－２ｋＰａ；离体灌注指上述状态下指背静脉压分别为（１．３２±０．１７）ｋＰａ，（４．２９±０．４８）ｋＰａ，（１６．８８±５．２５）ｋＰａ。在临床２５例３５指４３次静脉危象处理中，挤压法成功地治疗２１例３０指３９次静脉危象。认为，挤压法是治疗断指再植术后静脉危象值得尝试的疗法。

In search of a new method for treating venous crisis after replantation of the finger, the effect of instantaneous, quick and forceful squeezing on the belly of replanted finger (the so called SQUEEZINGG TECHNIQUE) was studied. In the animal experiment, 20 SD rats were used. The femoral veins and arteries were seperated in order to measure the venous pressure. The result showed that the venous pressure was (8.33±1.29)×10 -2 kPa in normal condition, (20.61±2.34)×10 -2 kPa in the condition simulating venous crisis and (73.9± 5.74) ×10 -2 kPa on carrying out the squeezing technique. The second part of the experiment was performed on ten human fingers which were amputated because of trauma or other diseases. One of the arteriae digitales palmares propriae and two of its accompanied veins were disected, and all other blood vessles were ligated. The artery was irrigated with normal saline at a pressure of 12 kPa. When both veins were left open, the venous pressure was (1.32±0.17) kPa;(4.29±0.49) kPa,when both were ligated; and (16.88±5.25) kPa when the squeezing technique was applied at the time venous crisis developed.From May 1991 to May 1996, this method was used for 43 times in 25 cases (35 fingers) with venous crisis after replantation. It was successful for 39 times in 21 cases (30 fingers). It was very important that the performer should use the thumb and the index finger to squeeze just the belly of the involved finger, and that every squeeze should be forceful, quick and instantaneous. It was suggested that if this method was properly performed it could improve the survival rate of replanted fingers. The mechanism of squeezing technique in the treatment of venous crisis following replantation of finger was proposed.