影响断指患者再植成活率的危险因素

Risk factors affecting survival rate of finger replantation in patients severed finger

目的 探讨断指再植患者成活率的影响因素,改善再植成活率。方法 回顾性分析2012年6月~2014年6月沧县医院收治的263例单指断裂行再植术患者的临床资料,其中断指再植成活的187例患者为A组,未成活的76例患者为B组,对两组患者的一般临床资料、抑郁程度、焦虑程度以及再植术相关资料进行单因素分析,对影响手指再植成活率的危险因素进行Logistic回归分析。结果 两组患者的临床资料在性别、年龄、离断平面、断指保存方式、断指血运方面差异无统计学意义（P〉0.05）,损伤类型、离断程度、伤后就诊时间、术后皮肤温度、术后指腹弹性、术后毛细血管反应、术后断指颜色、抑郁程度差异有高度统计学意义（P〈0.01）;影响手指再植成活率危险因素其危险程度由高到低依次是：重度抑郁（OR=5.679,P=0.000,95%CI：2.891~8.739）、完全离断（OR=5.543,P=0.002,95%CI：2.347~9.882）、伤后就诊时间长（OR=5.388,P=0.012,95%CI：2.671~7.963）、术后毛细血管反应差（OR=4.987,P=0.014,95%CI：3.644~9.876）、术后指腹弹性差（OR=4.514,P=0.036,95%CI：1.365~8.846）、术后皮肤温度低（OR=3.287,P=0.041,95%CI：2.542~9.677）、术后断指颜色一般（OR=2.141,P=0.045,95%CI：1.242~5.211）。结论 影响手指再植成活率的主要危险因素为重度抑郁、完全离断、以及伤后就诊时间,因此在行手指再植术时应针对危险因素制定相应的措施,提高手指再植成活率。

Objective To explore the factors affecting survival rate of finger replantation, in order improve the survival rate of finger replantation. Methods The clinical data of 263 cases of patients with single severed finger treated with replantation in Cangxian People/s Hospital from June 2012 to June 2014 were retrospectively analyzed, 187 patients with survival of replantation were as the group A, 76 patients without survival of replantation were as the group B. The general clinical data, degrees of depression, degrees of anxiety, and related data of the two groups were analyzed by single factor analysis method, and the Logistic regression analysis method was carried out on the risk factors influencing the survival rate of finger replantation. Results There were no significant differences in the aspects such as gender, age, amputation plane, finger preservation method, finger blood transportation between the two groups （P 〉 0.05）, while the differences in the aspects such as types of injury, degrees of transection, treatment time after injury, postoperative skin temperature, postoperative finger flexibility, postoperative reaction, postoperative finger capillary color and degrees of depression were statistically significant （P 〈 0.01）. The risk factors affecting the survival rate of finger replantation from high to low in rank were major depression （OR = 5.679, P = 0.000, 95%CI： 2.891-8.739）, complete transection （OR = 5.543, P = 0.002, 95%CI： 2.347-9.882）, long treatment time after injury （OR = 5.388, P = 0.012, 95%CI： 2.671-7.963）, bad postoperative capillary reaction （OR = 4.987, P = 0.014, 95%CI： 3.644-9.876）, poor postoperative finger flexibility （OR = 4.514, P = 0.036, 95%CI： 1.365-8.846）, low postoperative skin temperature （OR = 3.287, P = 0.041, 95%CI： 2.542-9.677） and general postoperative finger color （OR = 2.141, P = 0.045, 95%CI： 1.242-5.211）. Conclusion The major risk factors affecting survival rate of finger replantation are severe depression, complete transection and treatment time after injury. Therefore, the appropriate measures should be formulated to improve the survival rate of finger replantation in the finger replantation.