激光散斑对比分析技术应用于再植指早期皮层血流灌注的分析研究

发布时间：2018-04-08 09:57

本文选题：激光散斑　切入点：断指再植　出处：《山东大学》2017年硕士论文

【摘要】：目的:使用激光散斑对比分析技术监测断指再植患者术后再植指皮层血流灌注情况,探讨断指再植术后再植手指早期微循环灌注的特点及规律,建立断指再植术后激光散斑对比分析技术测量再植指血液灌注量的参考值范围,并对不同动脉吻合数量和不同致伤原因患者的术后灌注量进行比较,为护理人员观察判断血运变化提供客观依据。方法:2016年4月1日至9月30日,152例患者进行断指再植手术治疗的患者,术后血运良好,男性患者112例,女性患者40例,平均年龄34.92±15.11岁。单指再植116例,双指再植32例,三指再植4例,再植指总共192根,术中吻合单支动脉再植60根手指,双支动脉132根手指。切割伤患者52例,断指72根,挤压伤患者100例,断指120根。分别按照吻合动脉数量和致伤原因将患者分组。采用PeriCam PSI System分别在术后第1～7天采集再植指血流灌注量及同患者对侧相应正常手指灌注量数据,数据以灌注量单位的形式表达。用统计学软件对数据进行分析。结果:再植指术后第1～7天灌注量分别为88.46±42.27、111.73±55.80、117.47±48.43、116.92±54.99、107.34±47.88、112.26±52.78、111.95±50.28。正常手指灌注量为180.11±25.71。术后第1～7天灌注量95%置信区间分别为73.47～103.45、94.12～129.34、102.38～132.56、100.00～133.85、91.82～122.86、94.40～130.12、93.50～130.39,正常手指灌注量95%置信区间为 167.32～190.89。术后第1天灌注量显著低于术后第2～4天、第6～7天,有统计学意义。第2～7天再植指灌注量对比没有统计学差异。术后第1～7天每日再植指血液灌注量显著低于正常手指,有统计学意义。吻合2支动脉的再植指在术后第1～4天、第6～7天灌注量均高于吻合1支动脉的再植指,仅术后第5天低于吻合1支动脉的再植指,每日两组再植指血流灌注量差异没有统计学意义。挤压伤再植指在术后第1～2天、第4～7天灌注量均高于切割伤再植指,仅术后第3天低于切割伤再植指,每日两组再植指血流灌注量差异没有统计学意义。结论:激光散斑对比分析技术具有非接触、无创伤、快速成像等优点,非常适用于微循环血流的测量。临床用于监测再植手指皮层血液微循环较有价值,为护理人员观察判断血运变化提供了客观依据。经灌注量测定分析,对于断指再植术后病情平稳,血循环恢复顺利的患者,再植指术后第1天血流灌注最差,第2～7天相对平稳,且较第1天明显增加,有统计学意义;术后第1～7天再植指灌注量不稳定,有比较大的波动,与正常手指相比有较大差距,具有统计学意义。手术中吻合2支动脉可以提高灌注量,但与吻合1支动脉相比,并没有统计学意义。吻合动脉数量的增加不能显著得提高灌注,不是再植指成活的决定因素,动静脉吻合的比例与吻合质量更加关键。只要断指具备再植指征,经过良好的手术处理,致伤原因可能并不影响再植指术后血流灌注量。
[Abstract]:Objective: to investigate the characteristics and regularity of early microcirculation perfusion of replanted finger after replantation of finger by using laser speckle contrast analysis technique to monitor the blood flow perfusion in the cortex of replanted finger after replantation of severed finger.The reference range of blood perfusion of replanted finger was measured by laser speckle analysis after replantation, and the postoperative perfusion of patients with different arterial anastomosis and different injury cause was compared.To provide objective basis for nursing staff to observe and judge the changes of blood circulation.Methods: from April 1 to September 30, 2016, 152 patients underwent replantation of severed fingers. The blood flow was good after operation. 112 male patients and 40 female patients with average age of 34.92 卤15.11 years.There were 116 cases of single finger replantation, 32 cases of double finger replantation, 4 cases of 3 finger replantation, 192 replanted fingers. 60 fingers were replanted by single branch artery and 132 fingers were replanted by double branch artery during operation.52 cases were incised, 72 fingers were amputated, 100 cases were crush injury, 120 fingers were amputated.Patients were divided according to the number of anastomotic arteries and the causes of injury.PeriCam PSI System was used to collect the blood flow volume of replanted finger and the corresponding normal finger perfusion data from the contralateral side of the same patient on the 1st day after operation. The data were expressed in the form of perfusion volume units.Statistical software was used to analyze the data.Results: the perfusion volume was 88.46 卤42.27111.73 卤55.80117.47 卤48.43116.92 卤54.99107.34 卤47.88112.26 卤52.78111.95 卤50.28on the 1st day after replantation.The normal finger perfusion was 180.11 卤25.71.The 95% confidence interval of perfusion volume on the 1st day after operation was 73.47 / 103.45 / 94.129.34102.38 / 132.560.001 / 133.85 / 91.82 / 91.82 / 94.40 / 130.120.120.120.120.50 / 93.50 / 130.39, respectively, and the 95% confidence interval of normal finger perfusion was 167.32 / 190.89.The perfusion volume on the first day after operation was significantly lower than that on the 2nd day and 6th day.On the 2nd day, there was no statistical difference in the volume of replantation finger perfusion.The daily blood perfusion of replanted fingers was significantly lower than that of normal fingers on the 1st day after operation.The perfusion volume of the replanted fingers of the two branches was higher than that of the replanted fingers of the anastomosed artery on the 1st day and the 6th day after operation, and was lower than that of the replanted fingers of the anastomosed artery on the 5th day after operation.There was no significant difference in blood perfusion between the two groups.The perfusion volume of the replanted finger was higher than that of the replanted finger on the 1st and 7th day after operation, but on the third day after operation, it was lower than that on the third day after operation. There was no significant difference between the two groups in the blood flow perfusion of the replanted finger every day.Conclusion: laser speckle contrast analysis has the advantages of non-contact, non-invasive and fast imaging, so it is very suitable for the measurement of blood flow of microcirculation.It is valuable to monitor the blood microcirculation of the replanted finger cortex and provide objective basis for nursing staff to observe and judge the changes of blood circulation.For the patients with stable condition and smooth blood circulation recovery after replantation of severed fingers, the perfusion was the worst on the first day after replantation, and relatively stable on the 2nd and 7th day, which was significantly higher than that on the first day.The perfusion volume of replanted fingers was unstable and fluctuated on the 1st day after operation, which was significantly different from that of normal fingers.Anastomosis of two branches increased the perfusion volume, but there was no statistical significance compared with the anastomosis of 1 branch artery.The increase in the number of anastomotic arteries can not significantly improve the perfusion and is not the decisive factor for the survival of replanted fingers. The proportion of arteriovenous anastomosis and the quality of anastomosis are more critical.As long as the finger replantation indication is available and the surgical treatment is good, the cause of injury may not affect the blood flow volume after replantation.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.6

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