偏振光红外线照射星状神经节结合血塞通对断指再植术后的影响

Polarized infrared radiation stellate ganglion combined with Xuesaitong impact on digital replantation

目的研究星状神经节阻滞(SGB)结合血塞通对断指再植术后的影响并分析其机制。方法 48例患者随机分为治疗组19例和对照组29例。再植术后治疗组采用患侧星状神经节激光照射结合血塞通静脉滴注治疗,对照组采用罂粟碱静脉注射。彩色多普勒超声检测再植指固有动脉指标,再植术前后血神经肽Y(NPY)和去甲肾上腺素(NE)及血浆组织型纤溶酶原激活物(t-PA)及其抑制剂-1(PAI-1)的含量。结果与治疗前比较,SGB后指动脉管径增粗,指动脉内峰值流速(VS)、舒张末期流速(VD)、平均流速(TVA)均增高,血管阻力指数(RI)降低,差异均有统计学意义(P<0.05)。治疗组治疗后患肢血液内各时点NPY和NE的含量较治疗前降低,且低于对照组,差异均有统计学意义(P<0.05)。治疗组静脉滴注血塞通后血浆t-PA上升,PAI-1较治疗前明显下降,差异均有统计学意义(P<0.05)。治疗组断指再植完全成活率为89.5%高于对照组的62.1%,差异有统计学意义(P<0.05)。结论 SGB结合血塞通静脉滴注可减少NPY和NE分泌、扩张痉挛的指固有动脉,并使血浆t-PA含量明显升高,血浆PAI-1含量明显下降,使指固有动脉附壁血栓形成几率降低而提高断指再植成活率。

Objective To study the impact of stellate ganglion block（SGB）combined with Xuesaitong on digital replantation and analyze its mechanism.Methods 48 cases were randomly divided into treatment group（19 cases）and control group（29 cases）,the treatment group were ipsilateral replantation stellate ganglion irradiation combined with intravenous Xuesaitong treatment,the control group intravenous injection of Papaverine.Color Doppler detected the artery indexof replanted fingers,neuropeptide Y（NPY）and norepinephrine（NE）before and after replantation and the content of plasma tissue-type plasminogen activator（t-PA）and its inhibitor-1（PAI-1）.Results Compared with before treatment,artery diameter enlargement,systolic velocity（VS）,enddiastolic velocity（VD）,average velocity（TVA）of digital arterial peak were increased after stellate ganglion block,and vascular resistance index（RI）decreased significantly（P0.05）.When after treatment,the content of NPY and NE in limb blood of treatment group were lower than before,and lower than that in control group,the difference was statistically significant（P0.05）.Plasma t-PA in treatment group was increased when after intravenous Xuesaitong,and PAI-1 was decreased than before,the differences were statistically significant（P0.05）.The total survival rate of replantation in treatment group was 89.5% higher than 62.1% in control group,the difference was statistically significant（P0.05）.Conclusion Stellate ganglion block combined with intravenous infusion of Xuesaitong can reduce the secretion of NPY and NE,expansion the artery spasm,and increase plasma t-PA,plasma PAI-1 is significantly decreased mean artery-laws caused reduce the risk of thrombus formation increase the survival rate of replantation.