血管危象预警控制体系对断指再植手术患者预后的影响

Influence of vascular crisis early warning control systemon prognosis of patients undergoing severed finger replantation

目的 观察血管危象预警控制体系应用于断指再植手术患者中的效果,为改善患者预后提供思路。方法 分别于医院推行血管危象预警控制体系管理模式前(2019年8月—2020年12月,对照组)和推行后(2021年1月—2022年3月,观察组),随机抽取断指再植患者55例和50例;对比2组患者的围术期指标(皮瓣坏死率、手术成功率、血管危象率),及治疗期间的治疗依从性[Morisky服药依从性量表-8(MMAS-8)]和并发症发生情况;评估患者出院6个月的手指功能康复情况[断肢再植功能评估标准、手功能量表(MHQ)],记录患者出院时的局部血流动力学水平[平均血流速度(Vm)、阻力指数(RI)、舒张期血流速度(Vd)];采用Spitzer生活质量指数(SQLI)、生活质量综合评定问卷(GQOLI-74),评价并比较2组患者的生活质量。结果 2组患者手术成功率、皮瓣坏死率差异无统计学意义(P>0.05);观察组的血管危象率(4.0%)低于对照组(16.4%),差异有统计学意义(χ^(2)=4.269,P=0.039)。出院时,观察组断肢再植功能评估总优良率(84.0%)高于对照组(67.3%),MHQ、GQOLI-74、SQLI、MMAS-8评分和Vm、Vd水平均高于对照组,RI水平低于对照组,差异均有统计学意义(P<0.05)。治疗期间,2组患者的并发症总发生率差异无统计学意义(P>0.05)。结论 血管危象预警控制体系下的管理模式可有效降低患者血管危象事件发生率,改善断指局部血流动力学指标,对提高患者生活质量及治疗依从性具有积极影响。

Objective To observe the effectiveness of the vascular crisis warning and control system applied to patients undergoing finger replantation surgery so as to provide insights for improving patient prognosis.Methods A total of 55 cases in the control group and 50 cases in the observation group were randomly selected among patients undergoing finger replantation surgery before(August 2019 to December 2020,control group)and after(January 2021 to March 2022,observation group)the implementation of the vascular crisis warning and control system management model.The perioperative indicators(flap necrosis rate,surgical success rate,vascular crisis rate),treatment compliance during the treatment period(assessed using the Morisky medication adherence scale-8(MMAS-8)),and occurrence of complications were compared between the two groups.The finger function recovery of patients at 6 months after discharge was evaluated using the criteria for evaluating the functionality of replanted limbs and the Michigan hand questionnaire(MHQ).The local hemodynamic levels(mean blood flow velocity(Vm),resistance index(RI),diastolic blood flow velocity(Vd))at the time of patient discharge were recorded.The quality of life of the two groups of patients was evaluated and compared using the Spitzer quality of life index(SQLI)and the general quality of life index-74(GQOLI-74).Results There was no statistically significant difference in the surgical success rate and flap necrosis rate between the two groups(P>0.05).The vascular crisis rate in the observation group(4.0%)was significantly lower than that in the control group(16.4%),with a statistically significant difference(χ^(2)=4.269,P=0.039).At the time of discharge,the observation group had a higher overall excellent rate in the evaluation of replanted limb functionality(84.0%)compared to the control group(67.3%).The MHQ,GQOLI-74,SQLI,MMAS-8 scores,as well as the levels of Vm and Vd were higher in the observation group,while the RI level was lower in the observation group(P<0.05).There was no statistically significant difference in the overall incidence of complications between the two groups during the treatment period(P>0.05).Conclusions Management model under vascular crisis early warning control system can effectively reduce the incidence rates of vascular crisis events and improve the local hemodynamic indicators in replanted fingers,and it has a positive impact on enhancing the quality of life and treatment compliance of patients.