断指再植术后血管危象影响因素的Meta分析

Meta-analysis of influencing factors for vascular crisis after finger replantation surgery

目的采用Meta分析断指再植术后发生血管危象的影响因素。方法通过知网、万方、维普、中国生物医学、Pubmed、Embase、Web of Science、Cochrane Library等数据库检索关于断指再植术后血管危象的研究。检索时间为建库至2023-12-31。按照纳入及排除标准筛选、提取、评价后进行危险因素的Meta分析,统计结果用比值比及95%置信区间表示。结果纳入17篇文献,2461例断指患者,其中568例再植术后发生血管危象,血管危象发生率为23.08%。Meta分析结果显示年龄(≤12岁)[OR=3.61,95%CI为1.99~6.55,P<0.01]、挤压撕脱伤[OR=4.16,95%CI为2.83~6.11,P<0.01]、缺血时间(≥10 h)[OR=3.20,95%CI为1.93~5.29,P<0.01]、末节离断[OR=2.47,95%CI为1.76~3.46,P<0.01]、吸烟史[OR=3.58,95%CI为2.26~5.66,P<0.01]和SAS评分[OR=11.73,95%CI为9.71~13.76,P<0.01]是断指再植术后血管危象的危险因素;性别(男)[OR=0.50,95%CI为0.34~0.80,P<0.01]、锐性切割伤[OR=0.33,95%CI为0.18~0.59,P<0.01]和钝性切割伤[OR=0.75,95%CI为0.58~0.98,P=0.03]是断指再植术后血管危象的保护因素。结论断指再植术后血管危象发生率较高,对女性、年龄≤12岁、有吸烟史、缺血时间≥10 h、挤压撕脱伤、末节离断和焦虑患者应采取针对性预防措施,以降低血管危象的发生率。

Objective To analyse the influencing factors for the occurrence of vascular crises after reimplantation of severed fingerswith Meta-analysis.Methods Studies on vascular crises after reimplantation of severed fingers were searched through the databases of CNKI,Wanfangdata,VIP,Sinomed,PubMed,Embase,Web of Science,and Cochrane Library.The search was conducted from the inception of the databases to December 31,2023.Meta-analysis of risk factors was performed after screening,extraction,and evaluation according to the inclusion and exclusion criteria,with statistical results expressed as odds ratios and 95%confidence intervals.Results Seventeen studies were included,encompassing 2461 patients with severed fingers,of which 568 developed vascular crises after reimplantation,with an incidence rate of 23.08%.The results of the Meta-analysis showed that age(≤12 years old)[OR=3.61,95%CI 1.99-6.55,P<0.01],crush avulsion injury[OR=4.16,95%CI2.83-6.11,P<0.01],ischemiaduration(≥10 h)[OR=3.20,95%CI 1.93-5.29,P<0.01],terminal segmental amputations[OR=2.47,95%CI 1.76-3.46,P<0.01],smoking history[OR=3.58,95%CI 2.26~5.66,P<0.01],and SAS score[OR=11.73,95%CI 9.71-13.76,P<0.01]were risk factors for vascular crises after reimplantation of severed fingers.Gender(male)[OR=0.50,95%CI 0.34-0.80,P<0.01],sharp cut injuries[OR=0.33,95%CI 0.18-0.59,P<0.01],and blunt cut injuries[OR=0.75,95%CI 0.58-0.98,P=0.03]were protective factors against vascular crises.Conclusion The incidence of vascular crises after reimplantation of severed fingers is high.Targeted preventive measures should be taken to reduce the incidence of vascular crises in patients who are female,≤12 years of age,with a history of smoking,an ischemic time of≥10 hours,crush avulsion injuries,terminal segmental amputations,and who exhibit anxiety.