带蒂穿支皮瓣血流动力学变化的临床观察研究

发布时间：2018-07-08 11:43

本文选题：带蒂穿支皮瓣 + 血流动力学　；参考：《广西医科大学》2015年硕士论文

【摘要】：目的：应用高频超声测定穿支动脉浅出点位置和监测术前、术后穿支血管血流动力学和管径大小变化,并观察其与皮瓣存活的关系,为其临床应用提供可靠的科学依据,从而有利于提高带蒂穿支皮瓣在临床中修复创面的疗效。方法：选取2014年4月至2015年2月我科行带蒂穿支皮瓣转位修复四肢软组织缺损患者31例,采用GE LOGIQ E9型超声多普勒诊断仪对术前穿支血管浅出点进行定位并与术中所见相对比,检测术前、术后1、2、3、5、7、14天带蒂穿支皮瓣中穿支动脉血流动力学参数及管径变化并计算其血流量大小,观察记录皮瓣大体的存活情况,分析皮瓣存活相关影响因素。所有临床资料均应用SPSS for Windows 16.0统计软件进行分析与处理,并以a=0.05作为其检验水准。结果：(1)术后穿支皮瓣穿支动脉流量较术前增高,术后1-5天时呈逐渐上升,峰值出现在第5天,然后呈逐渐下降趋势,至术后14天仍高于术前。(2)术前穿支动脉流量大小与旋转点至皮瓣存活最远端长度呈正相关(r=0.987,P=0.000)。(3)高频超声术前对穿支血管浅出点定位与术中所见位置完全符合。传统体表定位的皮瓣轴线与皮瓣穿支动脉血管链轴线有角度偏差,偏差成角约为4.70～8.5°(平均6.5°)。结论：(1)穿支动脉术前流量大小与术后皮瓣存活面积呈正相关,其流量大小的变化与皮瓣的病理生理变化相符,对判断皮瓣预后具有一定指导作用。(2)高频超声是测定穿支动脉浅出点和血管链轴线准确、有效的方法。
[Abstract]:Objective: to determine the location of perforator artery point and monitor the changes of blood flow dynamics and diameter of perforator vessels after operation by high frequency ultrasound, and observe the relationship with the survival of the skin flap, provide a reliable scientific basis for its clinical application, and thus help to improve the curative effect of the pedicled perforator flap in the clinical repair of the wound. From April 2014 to February 2015, we took the pedicle perforator flap to repair 31 cases of soft tissue defect in the extremities. The GE LOGIQ E9 ultrasonic Doppler diagnostic instrument was used to locate the superficial point of the perforator vessels before the operation and compared with those in the operation. The hemodynamic parameters of the perforator perforator flap in the pedicle perforator flap were detected before the operation. SPSS for Windows 16 statistical software was used to analyze and deal with the survival of skin flaps. All clinical data were analyzed and processed with a=0.05 Windows 16 software, and the results were as follows: (1) the flow of perforator perforator artery was increased after operation. High, 1-5 days after the operation gradually increased, the peak appeared at fifth days, and then declined gradually, to 14 days after the operation is still higher than before the operation. (2) the size of the perforating artery before the operation is positively correlated with the rotation point to the distal length of the flap survival (r=0.987, P=0.000). (3) the location of the perforating vessels and the position in the operation before Gao Pinchao sound operation is complete. There was an angle deviation between the axis of the skin flap and the axis of the vascular chain of the perforator artery of the traditional body surface, and the deviation angle was about 4.70 to 8.5 degrees (average 6.5 degrees). Conclusion: (1) the size of the perforating artery was positively correlated with the survival area of the flap after operation, and the change of the flow size was consistent with the pathophysiological changes of the flap. (2) high frequency ultrasound is an accurate and effective method for determining the superficial point of perforating artery and the axis of vascular chain.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R622

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