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山东大学学报(医学版) ›› 2010, Vol. 48 ›› Issue (2): 153-156.

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镇痛联合急性等容稀释对移植皮瓣影响的相关性研究

丁明,宗波,付春兰,王丙琼,程庆钦   

  1. 解放军89医院麻醉科, 山东  潍坊  261021
  • 收稿日期:2009-09-14 出版日期:2010-02-16 发布日期:2010-02-16
  • 作者简介:丁明,男,科主任,硕士研究生导师,主任医师,主要从事显微外科组织移植与疼痛和应激关系方向的研究。 E-mail:dwg069@163.com

Effects of hemodilution combined with preemptive analgesia  on haemodynamics in free tissue graft

DING Ming, ZONG Bo, FU Chunlan, WANG Bingqiong, CHENG Qingqin   

  1. Department of Anesthesiology, the No. 89 Hospital of PLA, Weifang 261021, Shandong, China
  • Received:2009-09-14 Online:2010-02-16 Published:2010-02-16

摘要:

目的  探讨血液稀释联合超前镇痛对移植组织血流动力学影响。方法  选择胫骨前软组织缺损采用股前外侧皮瓣修复患者160例,按照麻醉方法随即分为4组,A组:血液稀释联合超前镇痛,B组:血液稀释,C组:超前镇痛,D组:对照组。动态监测手术前后血小板计数、皮质醇、血清去甲肾上腺素含量、部分凝血酶时间、凝血酶原时间、并观察各组皮瓣血管危象发生及皮瓣成活率。结果  术前各组指标差异无统计学意义;A组手术前后各指标间差异无统计学意义;B组术后皮质醇、APTT及PT显著增高;C组PLT、HCT显著增高,而皮质醇、血清去甲肾上腺素含量增高差异无统计学意义;D组变化同B组。血管危象发生率A<B<C<D组,皮瓣成活率A>C>B>D组。结论  血液稀释联合超前镇痛可明显改善修复组织的血液循环,提高成活率。

关键词: 血液稀释;移植组织;血液循环;高凝状态;去甲肾上腺素

Abstract:

Objective  To investigate the effects of hemodilution combined with preemptive analgesia on haemodynamics in free tissue graft. Methods  160 patients whose anticus tibialis soft tissue was lost and was repaired with a thigh anterolateral flap were randomly placed into 4 groups: the hemodilution combined with preemptive analgesia group (group A), the hemodilution group(group B), the preemptive analgesia group(group C) and the control group(group D). Plt, corticosteroid, serum norepinephrine, APTT and PT were detected perioperatively. The relationship between survival rate and blood vessel crisis of flap was observed. Results  There was no significant difference in the above indexes among the 4 groups preoperatively. Corticosteroid, serum norepinephrine, APTT and PT were significantly increased after operation in group B and group D.  PLT and PT were significantly increased after operation in group C. The incidence of blood vessel crisis was 2.5% in group A, 7.5% in group B, 2.5%  in group C and 10% in group D. Survival rate of the flap was 100% in group A, 95% in group B, 97.5%  in group C and 92.5% in group D. Conclusion  Hemodilution combined with preemptive analgesia can significantly improve the blood circulation and survival rate of the grafted tissue.

Key words: Hemodilution; Tissue graft; Blood circulation; Hypercoagulability; Norepinephrine

中图分类号: 

  • R614.3
[1] 丁明1, 宗波1, 王学平2. 芬太尼及甲泼尼龙琥珀酸钠对家兔骨骼肌缺血再灌注损伤的保护机制[J]. 山东大学学报(医学版), 2012, 50(9): 55-58.
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