断指再植成活率影响因素的Logistic回归分析

Logistic regression analysis of the influencing factors of the survival rate of finger replantation

目的探讨手指受伤类型、断指热缺血时间、指动静脉吻合之比及术者显微技术水平等因素对断指再植成活率的影响。方法用整群抽样的方法，收集华中科技大学同济医学院附属协和医院2005年12月至2008年12月做过断指再植手术的全部住院患者。用Logistic回归分析断指再植成活率的影响因素。结果共收集612例692指断指病例，成活率为89％。在控制混杂因素后，切割伤断指再植成活率是撕脱伤断指再植成活率的36倍[95％ci（12．11—107．82），P〈0．（301]，挤压伤断指再植成活率是撕脱伤断指再植成活率的15倍[95％CI（4．31—54．35），P〈0．001]，断指热缺血时间与断指再植成活率之间呈负相关（β=-1．36，Se=0．168，P〈0．001），指动静脉吻合之比以2：4和1：2断指再植成活率最高，总住院医师主刀的断指再植成活率是低年资住院医师断指再植成活率的18倍[95％0（8．66—39．41），P〈0，001]。结论手指受伤类型、断指热缺血时间、指动静脉吻合之比和术者的显微操作水平是断指再植存活的影响因素。

Objective ： investigate the influence of types of finger injuries, warm ischemic time, artery vein anastomosis ratio, surgeon＇s level of microsurgery expertise and other factors on the survival rate of finger replantation. Methods All the cases of finger replantation done at the Union Hospital, Huazhong University of Science and Technology from December 2005 to December 2008 were collected using cluster sampling, logistic regression analysis was conducted to identify factors that influence the survival rate of replantation. Results A total 692 finger replantations of 612 patients were collected. The overall survival rate was 89%. After controlling for confounding factors, the survival rate of replantation in clean cut injuries was 36 times that in avulsion injuries （95% CI = 12.11 - 107.82, P 〈 0. 001）. The survival rate of replantation in crush injuries was 15 times that in avaalsion injuries （95% CI = 4.31 - 54.35, P 〈 0.001）. Warm isehemia time was negatively correlated to the survival rate of replantation （ β = - 1.36, Se = 0. 168, P 〈 0. 001 ）. Replantation survival rate was the highest when the artery vein anastomosis ratio was 2 ： 4 or 1 ： 2. The overall survival rate of replantation performed by chief residents was 18 times that by junior residents （95% CI = 8.66 - 39.41, P 〈 0.001 ）. Conclusion Finger injury type, warm ischemia time of severed fingers, artery vein anastomosis ratio, and microsurgery proficiency of the surgeon are factors that affect replantation survival.