低分子肝素钙联合非洛地平对预防断指再植术后血管危象的疗效研究

Efficacy of Nadroparin Calcium Combined with Felodipine in Prevention of Vascular Crisis after Severed Finger Replantation

目的:探讨低分子肝素钙联合非洛地平对预防断指再植术后血管危象的疗效,并对药物的副作用进行观察。方法:选择我院2006年1月至2012年1月收治入院的断肢再植患者80例(100指)临床资料进行回顾性分析,按随机原则将80例患者90指分为两组,在常规三抗治疗的基础上,治疗组给予低分子肝素联合非洛地平治疗,以低分子肝素钙针0.4 mL皮下注射,每12 h 1次。口服非洛地平缓释片5mg,1次/24h,共7d。观察记录血液流变学指标变化情况,以及断指再植动脉危象发生情况、成活情况、药物副作用,并进行统计学分析。结果:两组经治疗后动静脉吻合数比例、血管移植及平均手术时间等手术情况比较无统计学意义(P>0.05);两组治疗后治疗组血管危象及再植肢体坏死情况明显少于对照组,且差异有统计学意义(P<0.05);治疗组受伤至术后72h断指患者全血粘度、全血低切粘度、血小板粘附率、纤维蛋白原、血浆粘度、红细胞比容等血液流变学指标与对照组比较差异显著(P<0.05或0.01);治疗组断指再植手术完成72h之后血液流变学各项指标基本恢复正常,与对照组比较无统计学意义(P>0.05);治疗组为出现头疼、腹痛、腹胀等不良反应;对照组出现不良反应12例(30.0%),两组比较差异有统计学意义(X2=10.368,P<0.05)。结论:低分子肝素钙联合非洛地平对断指再植术后血管危象能起到安全有效的预防作用,同时药物副作用少,患者对药物的依从性及耐受性好。

Objective： To investigate the efficacy of nadroparin calcium combined with felodipine in the prevention of vascular crisis after severed finger replantation and observe the side effects. Method： Clinical data of 80 patients（ 100 fingers） who were given severed finger replantation in our hospital from January2006 to January 2012 were retrospectively analyzed,and all patients were randomly divided into 2 groups,on basis of conventional therapy,the treatment group was given nadroparin calcium and felodipine treatment,nadroparin calcium needle（ 0.4 ml） was given by subcutaneous injection,once every 12 h. felodipine sustained release tablets（ 5 mg,Oral） was given once every 24 hours,all patients were given seven days treatment. The hemorheology changes and replantation artery crisis situation,survival situation,medication side effects were observed and recorded. Result： After treatment,arteriovenous anastomosis percentage,vascular grafts and mean operative time of two groups was not significantly different（ P＆gt;0.05）; vascular crisis and replanted limb necrosis was significantly less than the control group,and the difference was significant（ P ＆lt;0.05）; From injury to 72 h after operation,whole blood viscosity,whole blood shear viscosity,platelet adhesion rate,fibrinogen,plasma viscosity,hematocrit of treatment group was significantly different from control group（ P ＆lt;0.05 or 0.01）. Hemorheological index of treatment group in 72 h after operation all recovered normal,compared with the control group,the difference was not significant（ P＆gt; 0. 05）. There was no headache,abdominal pain,bloating and other adverse reactions in treatment group; and 12 cases of adverse reactions in control group（ 30.0%）,the difference was significant（ x2 = 10.368,P＆lt;0.05）. Conclusion： Nadroparin calcium combined with felodipine is safe and effective in prevention of vascular crisis,while side effects is few,patients’ compliance and drug tolerance is well.