严重创伤断指再植前后血小板活化检测的临床意义

THE FLOW CYTOMETRIC ANALYSIS OF ACTIVATED PLATELETS OF SEVERED FINGER BY SEVERE INJURY BEFORE AND AFTER REPLANTATION

应用流式细胞技术对３２例手指挤压、绞轧伤断指患者再植前后外周血血小板ｐ选择素（ＣＤ６２ｐ）进行了检测。选择ＣＤ６２ｐ明显增高的１７例患者，采用大剂量尿激酶等有效抗凝治疗，术后第２，３天再进行ＣＤ６２ｐ检测。结果显示，术前及术后外周血ＣＤ６２ｐ均较正常对照组增加，有显著性差异（Ｐ＜０．０１）；术后第２，３天的ＣＤ６２ｐ检查结果大致在正常范围，临床上血管危象的发生亦明显减少。提示，对于挤压、绞轧等创伤较重的断指，易出现高血凝状态，应特别注意抗凝措施，以提高再植成活率。ＣＤ６２ｐ检测可以作为灵敏的血小板活化指标。

To investigate the significance of activated platelet levels before and after surgical operation in patients with severed finger by severe injury, the Pselectin (CD62p) positive platelet percent in peripheral blood was studied in 32 patients before and after operation by flow cytometric immunology. At the second and third day after operation, seventeen patients, which in a high positive platelet percent, were measured again after anticoagulation treatment with a large dose of urokinase etc. The results were that the levels of CD62p positive platelet in peripheral blood before and after operation were significantly higher than that of the normal group (P<0.01). The CD62p positive platelet percent was increased not much more in the anticoaggulation patients than in the normal ones (P>0.05). There were a few vascular crisis observed. This study suggested that severed fingers by a crushing or wringing injury enhance the platelet activity and resulted in hypercoagulation, thus anticoagulation measures should be taken to avoid possible thrombosis and improve the survival rate of replantation. CD62p was one of the sensitive indices of activated platelet, which could be used in calculating hypercoagulation accurately.