己酮可可碱干预随意皮瓣的成活 激光多普勒血液灌流成像评价

Pentoxifylline for random flap survival:Evaluation using laser-Doppler blood reperfusion image

背景:己酮可可碱作为一种有效改善血液流变学的药物,20世纪60年代已作为血管扩张药应用于治疗血管性疾病及外周血管疾病。但应用己酮可可碱的血液流变学作用,作用于皮瓣微循环促进皮瓣成活还尚无相关研究。目的:应用己酮可可碱干预临床随意皮瓣,评价其促进皮瓣成活和改善皮瓣血循环的状态。方法:选择河北医科大学第一医院烧伤整形外科收治的皮肤组织缺损进行随意皮瓣修复患者39例,男性27例,女性12例,年龄7～54岁。将39例病例以抽签法随机分为对照组和药物组。药物组在随意皮瓣术后第2天静脉点滴给予己酮可可碱250mL,1次/d,直至皮瓣修复术后14d,于皮瓣断蒂术后第1天再次静脉点滴给予己酮可可碱氯化钠注射液250mL,1次/d,至断蒂术后7d。对照组未给予己酮可可碱治疗。以LISCA型激光多普勒血液灌流成像仪评价皮瓣移植后断蒂前、断蒂后皮瓣远端与皮瓣蒂部血流灌流量PU值。结果与结论:39例患者均完全治愈出院,无一例中断实验。断蒂前,药物组和对照组皮瓣远端PU值变化较为明显,呈逐渐上升趋势,药物组高于对照组(P<0.05);断蒂后,两组皮瓣远端PU值降低,差异无显著性意义(P>0.05)。断蒂前,两组皮瓣蒂部PU值降低后逐渐升高,对照组上升缓慢,药物组术后7d即进入血液灌流稳定期,两组差别不显著(P>0.05);断蒂后即刻,两组皮瓣蒂部PU值降低,此后药物组PU值升高较对照组显著(P<0.05)。两组随意皮瓣均全部成活,断蒂后均成功修复皮肤缺损。证实己酮可可碱可明显提高随意皮瓣术后整体的血液灌流,有利于促进皮瓣早期成活,早期断蒂,有效缩短愈合时间。

BACKGROUND：Pentoxifylline（PTX）,as an effective drug to improve blood rheology,has been used as a vasodilator for the treatment of vascular diseases and peripheral vascular disease science 1960s.But the role of PTX on skin blood flow to improve flap survival remains still unclear.OBJECTIVE：Through the clinical application of PTX therapy,the dynamic observation of random flap to understand that the PTX can promote flap survival and improve blood circulation of flap.METHODS：A total of 39 patients（27 males and 12 females aging 7-54 years） with skin tissue defect undergoing random flap repairing were selected from Department of Burn and Plastic Surgery,First Hospital of Hebei Medical University.The 39 cases were randomly divided into control group and drug group.Patients in the drug group were given intravenous injection of 250 mL PTX at day 2 after random flap operation,once a day,until 14 days after flap repairing surgery.On the first day after flap pedicle surgery,250 mL PTX sodium chloride injection was intravenously given,once a day,until 7 days after flap pedicle surgery.The control group was not given PTX treatment.The value of blood perfusion（PU） was measured using laser-Doppler blood reperfusion image after flap transplantation,before and after pedicle division.RESULTS AND CONCLUSION：All 39 patients were completely cured and discharged,with no interruption experiments.Before pedicle division,PU value at distal flap in both drug and control groups were increased obviously,and the PU value in the drug group was significantly higher than control group（P0.05）;after pedicle division,the PU value in the two groups were decreased,and there was no significant difference between the two groups（P0.05）.Prior to pedicle division,the PU value of pedicle was gradually decreased and then increased in the drug group,and that in the control group was gradually increased.On the seventh day,the PU value of pedicle was stable in the drug group,and there was no significant difference between the two groups（P0.05）;after pedicle division immediately,the PU values of pedicle were decreased in the two groups,and then the increase in the drug group was remarkable compared to control group（P0.05）.Two sets of random flaps all survived,and skin defects were successfully repaired after pedicle division.PTX can markedly increase blood perfusion after random flap transplantation,promote flap survival and pedicle division in an early stage,and effectively shorten the healing time.