D-二聚体监测观察岛状皮瓣早期血运

D-dimer level monitoring in the early postoperative observation of island flap blood supply

目的评估监测D-二聚体指标变化对于手部岛状皮瓣术后早期血运观察的临床价值。方法前瞻性对照分析研究自2013年7月至2015年7月我科收治的手部皮肤软组织缺损行岛状皮瓣手术治疗患者共28例，男25例，女3例；年龄13～56岁。监测术后24、48、72h的D-二聚体（D—dimer，DD）实验室指标，以术后是否出现危及皮瓣存活的危象为观察标准，分为危象组（n=12）和对照组（n=16），对比术后不同时间以及两组间的DD值变化情况。结果危象组DD值在术后持续显著升高，并且在术后24、48、72h间差异均有统计学意义（P〈0．05）；对照组的DD值在术后24h、48h显著升高，差异有统计学意义（P=0．002），在术后48h、72h指标升高变化差异无统计学意义（P=0．074）。危象组与对照组在术后24h差异无统计学意义（P=0．511），住术后48、72h时危象组相对于对照组指标显著升高，并且差异有统计学意义（P=0．032，P=0．003）。结论D-二聚体指标监测对于手部岛状皮瓣术后皮瓣危象早期识别具有一定的临床意义，可在一定程度上指导术后及时调整用药和采取挽救措施。

Objective To evaluate the clinical value of monitoring D-dimer level in the early postoperative observation of island flap blood supply. Methods A prospective controlled clinical study was performed with 28 patients who underwent island flap transfer for coverage of soft tissue defect of the hand from July 2013 to July 2015. There were 25 male patients and 3 female patients whose ages ranged from 13 to 56 years. D-dimer level was measured 24, 48 and 72 hours postoperatively in all the patients, who were divided into the crisis group （n = 12） and the control group （n = 16） based on whether there was vascular erisis. Tbe D-dimer values were compared between groups and among various postoperative time points. Results D-dimer level in the crisis group went up continuously. There were significant differences among the values measured at 24, 48 and 72 hour postoperative time points （P 〈 0.05）. In the control group, D-direct level was found to have risen significantly from 24 hours to 48 hours postoperatively （ P = 0. 002）, hut not from 48 hours to 72 hours （ P = 0.074）. There was no statistieally signifieant difference between D-dimer values of the crisis group and of the control group at 24 hours postoperatively （ P = 0. 511 ）. However D-dimer levels in the crisis group were significantly higher than those in the control group at 48 and 72 hour postoperative time points （ P = 0. 032, P = 0.003）. Conclusion Monitoring the D-dimer level is of certain value for identifying vascular crisis at the early postoperative stage after island flap transfer, It can be used to guide medication adjustment and implementation of interventions to rescue the flap.