尿激酶及肝素钠对提高断指再植成活率及促进血管新生的效果比较

Comparison effects of urokinase and heparin sodium on improving the survival rate of replantation of severed fingers and promoting angiogenesis

目的比较应用尿激酶及肝素钠对提高断指再植成活率及促进血管新生的效果。方法将行断指再植术的189例患者(312指)按照随机数字表法分为尿激酶组(99例,168指)和肝素钠组(90例,144指)。比较两组血管危象发生率、断指再植成活率、血液流变指标、凝血功能情况以及碱性成纤维生长因子(b FGF)、血管内皮生长因子(VEGF)水平的差异。结果血管危象发生率尿激酶组低于肝素钠组(26. 8%vs 38. 2%),断指再植成活率尿激酶组高于肝素钠组(89. 3%vs 80. 6%),差异均有统计学意义(P <0. 05)。给药5 d后,全血高切黏度、中切黏度及低切黏度尿激酶组均低于肝素钠组,凝血酶原时间、活化部分凝血酶时间及凝血时间尿激酶组均长于肝素钠组,差异均有统计学意义(P <0. 05)。给药3 d时,尿激酶组b FGF及VEGF水平达到最高值,且高于肝素钠组,差异有统计学意义(P <0. 05)。结论相对肝素钠,断指再植术后给予尿激酶更能减少血管危象发生,改善血液流变学指标,延长血液凝固时间,增加b FGF及VEGF水平,从而提高断指再植成活率。

Objective To compare the application effect of urokinase and heparin sodium to improve the survival rate of replantation of severed fingers and promote angiogenesis. Methods The 189 patients (312 fingers) who underwent replantation of the severed fingers were divided into the urokinase group (99 cases, 168 fingers) and the heparin sodium group (90 cases, 144 fingers) according to the random number table method.The incidence rate vascular crisis,the survival rate of replantation of severed fingers,the blood rheology index, coagulation function and the levels of basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) were compared between the two groups. Results The incidence rate of vascular crisis was lower in the urokinase group than in the heparin sodium group (26.8% vs 38.2%), and the survival rate after regenerative and regression was higher in the urokinase group than in the heparin sodium group (89.3% vs 80.6%). The difference between the two indexes was statistically significant ( P <0.05). After 5 d of administration, the high-viscosity, mid-cut viscosity and low-cut viscosity of the urokinase group were lower than those of the heparin sodium group,the prothrombin time, activated partial thrombin time and clotting time were all longer in the urokinase group than in the heparin sodium group. The indicators were statistically significant between the two groups( P <0.05). At 3 d after administration, the levels of bFGF and VEGF in the urokinase group reached the highest value were higher than those in the heparin sodium group ( P <0.05). Conclusions Relative to heparin sodium, urokinase after replantation of severed fingers can reduce vascular crisis, improve blood rheology, prolong blood clotting time, increase bFGF and VEGF levels, and improve the survival rate of finger replantation.