高海拔地区断指（趾）再植血液流变学改变及提高液体灌注量对成活率干预作用研究

发布时间：2018-08-20 13:49

【摘要】：目的:断指患者受伤至术后72h之内,在抗凝、解痉、抗炎的情况下,根据断指再植患者术后不同时段血液流变学指标的变化,通过突击扩容观察全血粘度、血浆粘度、红细胞比容、血小板粘附率和纤维蛋白原等血液流变学改变。探讨提高液体灌注量在高海拔地区断指再植术中的临床意义。方法:对将60例高海拔地区断指再植患者随即分为两组各30例。对照组,采取传统手术方法,术后补液1500ml~2000ml,高灌注组,在采取传统手术方法的基础上通过提高液体灌注量,术后补液达3000ml~3500ml,两组患者分别于术后72h内在抗凝、解痉、抗炎的情况下,在术后第1、3、5、7、14d动态观察检测血液流变学中血粘度、血沉方程K值、压积、血沉、全血高、中、低切变化等指标,并统计手术成活率及并发症等。结果:术后第1d和3d,两组血液流变学有显著统计学意义,对照组手术总成活率76.67%,并发症10.13%,高灌注组成活率92.67%,并发症8.70%。结论:高海拔地区适当提高液体灌可明显提高断指再植术后成活率,减少并发症,提高再植时限,在高海拔地区具有重要推广意义。
[Abstract]:Objective: to observe the whole blood viscosity and plasma viscosity of the patients with finger amputation within 72 hours after operation according to the changes of hemorheology indexes in the patients with replantation of the severed fingers at different time after operation. Erythrocyte volume, platelet adhesion rate, fibrinogen and other hemorheology changes. To explore the clinical significance of increasing fluid perfusion in replantation of severed fingers at high altitude. Methods: 60 cases of replantation of severed fingers in high altitude area were randomly divided into two groups (30 cases each). In the control group, the volume of fluid was increased to 3000ml / 3500ml by increasing the volume of fluid on the basis of the traditional operation method. The two groups were treated with anticoagulant, antispasmolysis and anti-inflammation respectively at 72 hours after operation. Blood viscosity, ESR equation K value, hematocrit, erythrocyte sedimentation rate (ESR), whole blood high, middle and low shear changes were observed and measured dynamically on the 1st day, 3rd day, 714 d after operation, and the survival rate and complications of the operation were statistically analyzed. Results: on the 1st and 3rd day after operation, there was significant difference in hemorheology between the two groups. In the control group, the total survival rate was 76.677.The complications were 10.13. In the high perfusion group, the survival rate was 92.677.The complication was 8.70. Conclusion: it is important to improve the survival rate of severed finger replantation, reduce complications and increase the time of replantation in high altitude area.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R658.1

【相似文献】