酸枣仁汤对断指再植术后恢复、血流动力学及外周血VEGF、bFGF的影响

Effects of Suanzaoren Decoction(酸枣仁汤)on Recovery,Hemodynamics and Vascular Endothelial Growth Factor and Basic Fibroblast Growth Factor in Peripheral Blood After Replantation of Severed Finger

目的:研究酸枣仁汤对断指再植术后恢复、血流动力学及外周血中血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)的影响。方法:选取60例断指患者,按照随机数字表法分为对照组和研究组各30例,每组35根断指。术后,对照组静脉滴注尿激酶,研究组同时服用酸枣仁汤。评价两组患者临床疗效。治疗5 d后,对再植指舒张期血流速度(Vd)、收缩期峰值速度(Vs)、平均血流速度(Vm)和阻力指数(RI)进行检测;采用视觉模拟评分法(VAS)对患者断指疼痛进行评价。观察治疗5 d时两组患者断指的成活率及血管危象的发生率。分别于术前和给药后5 d时,检测凝血酶原时间、凝血时间和活化部分凝血酶时间;采用酶联免疫吸附法测定患者血清中VEGF和bFGF水平。观察治疗期间两组不良事件的发生率。结果:研究组临床治疗总有效率为94.29%,显著高于对照组(77.14%,P<0.05)。治疗5 d后,研究组血流动力学参数Vs、Vd和Vm水平均显著高于对照组(P<0.05),RI水平显著低于对照组(P<0.05)。研究组康复时间、肿胀程度及疼痛评分与对照组比较均显著降低(P<0.05)。研究组断指移植术后成活率显著高于对照组(P<0.05),血管危象发生率显著低于对照组(P<0.05)。治疗后,研究组和对照组患者外周血中VEGF和bFGF水平、凝血酶原时间、凝血时间、活化部分凝血酶时间均显著增加(P<0.05),且研究组增加更明显(P<0.05)。研究组总不良反应发生率为8.75%,显著低于对照组(31.43%,P<0.05)。结论:酸枣仁汤可以显著改善断指局部血流动力学,延长血液凝固时间,增加外周血中VEGF和bFGF水平,促进术后恢复,提高断指再植术后临床疗效。

Objective:To study the effects of Suanzaoren Decoction(酸枣仁汤)on recovery,hemodynamics,vascular endothelial growth factor(VEGF)and basic fibroblast growth factor(bFGF)in peripheral blood after replantation of severed fingers.Methods:Sixty patients with severed fingers were included and randomly divided into control group and research group,30 patients in each group,with 35 severed fingers in each group.After operation,the control group received intravenous urokinase,and the research group were further treated with oral administration of Suanzaoren Decoction.Clinical efficacy in both groups was evaluated.After 5 days of treatment,the diastolic blood flow velocity(Vd),systolic peak velocity(Vs),mean blood flow velocity(Vm)and resistance index(RI)of replanted fingers were measured.The visual analogue scale(VAS)was used to evaluate the pain of the severed finger,and the swelling degree of the severed finger was evaluated according to the self-made evaluation standard.The survival rate of severed fingers and the incidence of vascular crisis in two groups were observed after 5 days of treatment.The prothrombin time,coagulation time and activated partial thrombin time were measured before operation and 5 days after administration.Serum VEGF and bFGF levels were measured by enzyme-linked immunosorbent assay.The incidence of adverse events in the two groups was observed during treatment.Results:The total efficacy rate of clinical treatment in the research group was 94.25%,significantly higher than that in the control group(77.14%,P<0.05).After 5 days of treatment,the levels of hemodynamic parameters including Vs,Vd and Vm in the research group were significantly higher than those in the control group(P<0.05),and the level of RI was significantly lower than that in the control group(P<0.05).The recovery time,swelling degree and pain score in the research group were reduced more than those in the control group(P<0.05).The survival rate of severed finger transplantation in the research group was significantly higher than that in the control group(P<0.05),and the incidence of vascular crisis was significantly lower than that in the control group(P<0.05).After treatment,the levels of VEGF and bFGF,prothrombin time,coagulation time and activated partial thrombin time in the peripheral blood in the research group and the control group increased significantly(P<0.05),especially in the study group(P<0.05).The total incidence of adverse reactions in the study group was 8.75%,and was significantly lower than that in the control group(31.43%,P<0.05).Conclusions:Suanzaoren Decoction can significantly improve the local hemodynamics of severed fingers,prolong the blood coagulation time,increase the levels of VEGF and bFGF in peripheral blood,promote postoperative recovery and improve the clinical effectiveness in patients with replantation of severed fingers.