断指再植手术成活相关因素分析及临床对策

Related factors and clinical countermeasures of replantation operation survival

目的 探讨断指再植手术成活相关因素及临床对策.方法 选择行断指再植手术的患者27例,对断指再植的成活率与患者的各相关因素进行单因素和多因素Logistic回归分析.结果 需要再植的手指为35指,断指再植成活率为85.7％.成活组与未成活组在不同伤后处理方式、不同受伤原因、是否静脉嫁接、热缺血时间长短、是否血栓形成、是否存在血管危象差异有统计学意义（χ2=6.386、3.889、4.704、6.176、10.802、4.564,均P＜0.05）.经Logistic多因素回归分析显示伤后处理方式、受伤原因、是否静脉嫁接、热缺血时间、是否有血栓形成、是否存在血管危象等因素对断指再植的成活率影响显著（r =0.902、0.957、0.922、1.825、2.053、1.026,均P＜0.05）.结论 为提高断指再植手术成活率,在断指再植术前应对患者进行调查评估,作好适应证的选择,综合考虑各方面影响因素,及时采取有针对性的预防措施.

Objective To investigate the related factors on survival rate of digital replantation and clinical measures.Methods 27 patients with digital replantation were selected,patients＇various aspects relevant factors on the survival rate of digital replantation were analyzed by the single factor analysis and multi-factor Logistic regression.Results 35 fingers were needed to be replanted,the successful rate was 85.7%.There were significant differences in survival rate based on different treatment after injury,different injury reason,use of the vein graft,duration of warm ischemia,whether thrombosis,whether vascular crisis between survival group and non-survival group （χ2 =6.386,3.889,4.704,6.176,10.802,4.564,all P 〈 0.05）.The results of multivariate Logistic regression analysis showed that processing method after injury,injury reason,use of the vein graft,warm ischemia time,whether thrombosis,whether vascular crisis were the factors directly affected the survival rate （r =0.902,0.957,0.922,1.825,2.053,1.026,all P 〈 0.05）.Conclusion In order to improve the digital replantation survival rate,patients should be investigated and assessed before digital replantation.The indications should be reasonable selected,factors are compositely considered,preventive measures are taken timely.