不同药物在游离皮瓣移植术预防血管危象中的疗效比较

Clinical efficacy of different drugs in preventing vascular crisis after free flap transplantation

目的探讨不同药物预防游离皮瓣移植术后血管危象的临床效果。方法我院2011年3月至2013年8月共有105例患者接受游离皮瓣移植术,按照随机分层分组法将105例患者分为观察组和对照组,对照组于术前和术后均给予低分子右旋糖酐,观察组给予红花注射液,观察两组术后移植区皮肤颜色、温度、肿胀出血情况、毛细血管回充盈情况及吻合区血管通畅情况,同时检测两组术后不同时间点血流动力学、血液流变学及凝血四项指标的变化。结果两组术后凝血四项指标及血流动力学参数与术前比较差异无统计学意义(P>0.05),观察组的各时间点凝血四项指标及血流动力学参数与对照组比较差异无统计学意义(P>0.05)。两组术后1周血液流变学参数与术后1 d比较,差异有统计学意义(P<0.05),观察组术后3 d血液流变学参数与对照组比较差异有统计学意义(P<0.05)。观察组临床总有效率为93.7%(59/63),不良反应发生率为6.3%(4/63),对照组临床总有效率为73.8%(31/42),不良反应发生率为4.8%(2/42),两组比较差异有统计学意义(P<0.05)。结论红花注射液能显著改善游离皮瓣移植术后患者的血液流变学参数,提高移植术成功率,对于预防血管危象和不良反应有重要的应用价值。

Objective To explore the clinical efficacy of different drugs on preventing the vascular crisis after free flap transplantation.Methods According to a stratified randomization method,105 cases of patients undergoing free flap transplantation in our hospital were divided into observation group and control group,control group was given dextran-40,observation group was given safflower injection,the clinical symptoms,hemodynamics,blood rheology and four indices of blood coagulation of the two groups were observed.Results There was no statistical significance in hemodynamics and four indices of blood coagulation when compared with any time point in the same group（P〈0.05）,there was no statistical significance in hemodynamics and four indices of blood coagulation between the two groups（P〈0.05）.There were significant differences in hemorheology parameters when 1 week after surgery compared with1 d after surgery in the same group（P〈0.05）,the observation group was significantly better than the control group in the hemorheology parameters after three days（P〈0.05）.The total clinical effective rate of the observation group was93.7%（59 /63）,the incidence of adverse reactions was 6.3%（4 /63）,the total clinical effective rate of the control group was 73.8%（31 /42）,the incidence of adverse reactions was 4.8%（2 /42）,there was significant difference between the two groups（P〈0.05）.Conclusion Safflower injection can significantly improve blood rheology parameters,it can significantly improve the free flap surgery success rates and has important clinical value in the prevention of vascular crisis and adverse reactions.