摘要
目的 探讨低分子肝素钙对皮瓣术后动静脉循环障碍治疗效果和安全性.方法 选取2016年7月至2017年12月本院收治皮瓣术后血运障碍患者108例作为研究对象,根据患者血运障碍类型分为动脉供血障碍（A组,46例）和静脉回流障碍（B组,62例）,采用随机表法将两组患者分为两个亚组,观察A组（23例）、对照组A组（23例）和观察B组（31例）和对照B组（31例）;观察组采用脐周真皮下注射低分子肝素钙＋静脉滴注治疗,对照组采用皮瓣真皮下注射低分子肝素钙治疗;比较各组皮温升高、肿胀、皮肤颜色异常、毛细血管回流征阳性及凝血功能和并发症发生情况.结果 使用肝素前、使用肝素后6h,观察组和对照组APTT、PT、Fib、D-D水平比较,差异均无统计学意义（均P＞0.05）;使用肝素后2h,观察组患者APTT、PT水平高于对照组[（45.7±4.1）s比（37.2±3.8）s,（19.7±2.3）s比（12.4±2.6）s],Fib、D-D水平低于对照组[（2.7±0.4）g/L比（3.1±0.5）g/L,（103.8±13.5）μg/L比（125.9±15.7）μg/L],均P＜0.05.观察A组患者皮温升高、肿胀、皮肤颜色异常、毛细血管回流征阳性发生率均低于对照A组[21.74％比60.87％,17.39％比47.83％,8.70％比34.78％,13.04％比56.52％,均P＜0.05];观察B组患者肿胀、毛细血管回流征阳性发生率均低于对照B组[29.03％比64.52％,6.45％比25.81％,均P＜0.05].观察A组皮瓣坏死率低于对照组A组,血肿发生率高于对照A组[4.35％比26.09％,30.43％比4.35％,均P＜0.05];观察B组皮瓣坏死率低于对照组B组,血肿发生率高于对照B组[6.45％比25.81％,38.71％比3.23％,均P＜0.05].结论 皮瓣术后动静脉循环患者中给予低分子肝素钙脐周注射和静脉滴注治疗,可提高患者疗效、降低皮瓣坏死率,但可增加血肿发生风险.
Objective To investigate the therapeutic effect and safety of low molecular weight heparin calcium for arteriovenous circulatory disturbance after skin flap surgery.Methods 108 patients with arteriovenous circulation disorder after skin flap surgery treated at our hospital from July,2016 to December,2017 were selected as study objects,and were divided into an arterial blood supply disorder （group A,n =46） and a venous return disturbance （group B,n =62） according to the disorder types.Group A and group B were randomly divided into an observation group A （n=23）,a control group A （n=23）,an observation group B （n=31）,and a control group B （n=31）.The observation group were peri-umbilicusly and subcutaneously injected and intravenously dripped low molecular weight heparin calcium,and the control group peri-umbilicusly and subcutaneously injected.The skin temperature increase,swelling,skin color abnormalities,positive capillary reflux,coagulation,and complications were compared between the groups.Results Before and 6 h after the heparin treatment,the APTT,PT,and levels of Fib and D-D in the observation group were not statistically different from those in the control group （all P 〉 0.05）.2 h after heparin administration,the APTT and PT were longer and the levels of Fib and D-D were lower in the observation group than in the control group [（45.7±4.1） s vs.（37.2±3.8） s,（19.7±2.3） s vs.（12.4±2.6） s,（2.7±0.4） g/L vs.（3.1±0.5） g/L,and （103.8±13.5） μg/L vs.（125.9±15.7） μg/L,all P 〈 0.05].The incidences of skin temperature increase,swelling,skin color abnormalities,capillary reflux syndrome were lower in the observation group A than in the control group A （21.74% vs.60.87%,17.39% vs.47.83%,8.70% vs.34.78%,and 13.04% vs.56.52%,all P 〈 0.05）.The incidences of swelling and capillary reflux syndrome were lower in the observation group B than in the control group B （29.03% vs.64.52% and 6.45% vs.25.81%,both P 〈 0.05）.The flap necrosis rate was lower and the incidence of hematoma was higher in the observation group A than in the control group A （4.35% vs.26.09% and 30.43% vs.4.35%,both P 〈 0.05）,and were so in the observation group B than in the control group B （6.45% vs.25.81% and 38.71% vs.3.23%,both P 〈 0.05）.Conclusion Periumbilicusly and subcutaneously injecting and intravenously dripping low molecular weight heparin calcium for patients with arteriovenous circulation disorder after skin flap surgery can improve the treatment effect and decrease the flap necrosis rate,but increase the risk of hematoma.
作者
周礼志
吴耀强
萧瑞宜
黄陈海
林婉媚
滕金美
Zhou Lizhi;Wu Yaoqiang;Xiao Ruiyi;Huang Chenhai;Lin Wanmei;Teng dinmei(Department of Pharmacy,Dongguan Mayong Hospital,Dongguan 523142,China)
出处
《国际医药卫生导报》
2018年第16期2441-2443,2447,共4页
International Medicine and Health Guidance News
基金
东莞市科技局科技计划项目（2016105101224）
关键词
皮瓣术
血管危险
低分子肝素钙
动静脉循环障碍
Flap surgery
Vascular danger
Low molecular weight heparin calcium
Arteriovenous circulatory disorders
