马来酸桂哌齐特对手部皮肤缺损带蒂皮瓣移植修复术后成活率及手功能的影响

Effect of cinepazide maleate on survival rate and hand function after repair of hand skin defects with pedicle flap

目的探讨马来酸桂哌齐特对手部皮肤缺损患者带蒂皮瓣移植修复术后皮瓣成活率及手部运动功能恢复的影响。方法选取2017年1月至2020年3月在浙江中医药大学附属江南医院行带蒂皮瓣移植修复的57例手部皮肤缺损患者,根据术后干预措施的不同分为对照组(28例)和观察组(29例),其中对照组患者术后接受常规康复训练,观察组患者在常规康复训练的基础上自术后3d开始给予马来酸桂哌齐特注射,观察记录两组患者的皮瓣成活率、皮瓣臃肿率,拆线及末次随访时的手部触觉、压觉、温度觉、两点辨别觉,手总主动活动度(total active movement,TAM)、手部功能(disability of the arm,shoulder and hand,DASH)评分和生活质量综合评定问卷(comprehensive quality of life assessment questionnaire,GQOL-74)评分并进行组间比较。结果两组患者的皮瓣成活率均为100%;对照组皮瓣臃肿率为10.71%(3/28),而观察组为6.90%(2/29),两组比较差异无显著性(P>0.05)。观察组拆线时和末次随访时的手部触觉、压觉及拆线时的手部温度觉、两点辨别觉均优于对照组,差异有显著性(P<0.05),而末次随访时两组的手部温度觉、两点辨别觉比较差异无显著性(P>0.05)。观察组拆线时的TAM优良率明显高于对照组(P<0.05),而末次随访时两组TAM优良率比较差异无显著性(P>0.05)。末次随访时两组患者的DASH评分、GQOL-74评分均明显优于拆线时(P<0.05),但拆线时和末次随访时两组间比较差异均无显著性(P>0.05)。结论手部皮肤缺损患者行带蒂皮瓣移植修复术后应用马来酸桂哌齐特具有较好的治疗效果,值得临床应用。

Objective To investigate the effect of cinepazide maleate on the survival rate of skin flaps and the recovery of hand motor function after pedicled skin flap transplantation in patients with hand skin defects.Method 57 patients with hand skin defects who underwent pedicle flap transplantation in our hospital from January 2017 to March 2020 were selected and divided into control group(28 cases)and observation group(29 cases)according to different postoperative interventions.Example,the patients in the control group received routine rehabilitation training after the operation,and the patients in the observation group were given cinepazide maleate injection from 3 days after the operation on the basis of routine rehabilitation training.The flap survival rate of the two groups was observed and recorded.Skin flap swelling rate,hand touch,pressure,temperature,two-point discrimination,total active movement(TAM),disability of the arm,shoulder and hand(DASH)score,and The comprehensive quality of life assessment questionnaire(GQOL-74)scores and compares between groups.Result The excellent and good rate of hand touch in the control group at the time of stitch removal and the last follow-up were lower than observation group(P<0.05).At the time of stitch removal,the temperature sensation of hands in control group was lower than observation group(P<0.05).At the last follow-up of the two groups,the pressure sensation in hands was significantly better than the time of stitch removal(P<0.05).At the time of stitch removal,the excellent and good rate of TAM in the observation group was higher than control group(P<0.05).At the last follow-up,the DASH score and GQOL-74 score of the two groups were significantly better than the time of stitch removal(P<0.05).Conclusion The application of cinepazide maleate to patients with hand skin defects after repairing with pedicle flap transplantation has a good therapeutic effect and is worthy of clinical application.