改良小切口放血护理在末节断指再植动静脉危象中的应用研究

Application of modified small-incision of finger in arteriovenous crisis after replantation

目的探讨改良小切口放血护理在末节断指再植动静脉危象中的应用价值。方法回顾性分析台州恩泽医疗中心集团路桥医院手足外科病房末节断指再植动静脉危象患者102例,分为对照组(n=51)和观察组(n=51)。对照组给予"挑拨"方式,观察组采用改良小切口放血。观察两组住院天数、并发症及再次手术发生率。结果对照组住院天数为(18.23±6.14)d,再次手术发生率为33.3%(17/51),感染和坏死并发症发生率分别为23.5%(12/51)和17.6%(9/51);观察组住院时间为(12.76±4.59)d,再次手术发生率为17.6%(9/51),感染和坏死并发症发生率分别为9.8%(5/51)和7.8%(4/51)。两组比较差异有统计学意义(均P<0.05)。两组术后情况比较,对照组血管危象发生11例,发生率为21.6%;再植指成活数35例,发生率为68.6%;患者满意度76.5%(39/51);观察组血管危象发生3例,发生率为5.9%;再植指成活数49例,发生率为96.1%;患者满意度94.1%(48/51),两组比较差异均有统计学意义(均P<0.05)。结论改良小切口放血护理能够减少末节断指再植动静脉危象,缩短患者住院时间,减少并发症,减少再次手术发生率,提高断指再植成活率,提高患者满意度。

Objective To study the application value of modified small-incision of finger in arteriovenous crisis after replantation. Methods 102 patients in Department of Hand and Foot of Luqiao Hospital of Taizhou Enze Medical Cen ter with vascular anastomosis were divided into observation group （n=51） and control group （n=51）. The control group adopted pricking, and the observation group adopted modified small-incision of finger. Then the time of hospital stay, incidence of complication and the rates of re-0Peration were compared between the two groups. Results The time of hospital stay were （18.23：1：6.14） days, the rates of re-operation was 33.3% （17/51） and the incidence of infection and necrosis were 23.5% （21/51） and 17.6% （9/51） in the control group, while the time of hospital stay were （12.76±4.59） days, the rates of re-operation was 17.6% （9/51） and the incidence of infection and necrosis were 9.8% （5/51） and 7.8% （4/51） in the observation group. There were significantly differences between them （P 〈 0.05）. The data after surgery between two groups were compared, 11 cases of vascular compromise in the control group had happened, and the rate of vascular crisis was 21.6%; 35 fingers were surviving and the incidence was 68.6%, the rate of patient satisfaction was 76.5% （39/51）; while in the observation group, 3 cases of vascular compromise had happened, and the rate of vascu- lar crisis was 5.9%; 49 fingers were surviving and the incidence was 96.1%, the rate of patient satisfaction was 94.1% （48/51）, there were significant differences between two groups （all P 〈 0.05）. Conclusion Modified small-incision of finger can reduce the time of hospital stay, in arteriovenous crisis after replantation, the rates of re-operation, and com- plications in arteriovenous crisis after replantation, improve the survival rate of replanted digits and and increase the patient satisfaction.