应用丹参、红花、川芎嗪干预显微外科术后血管危象的临床研究

目的:评价丹参、红花、川芎嗪注射液防治小血管吻合术后血管危象的临床疗效和安全性,并探讨其作用机理。方法:240例需行显微外科手术的患者,按照入院的先后顺序随机分成丹参治疗组、红花治疗组、川芎嗪治疗组和低分子右旋糖酐(以下简称低右)对照组,4组疗程均为10d。从血管通畅率及血管危象的发生率进行比较,并作血液流变学、凝血四项检查了解4组病人术后血液流变学及凝血功能的波动及差异性。结果:⑴各组平均术后通畅率为88.9%,表明各组均能有效预防血管危象,其中丹参、红花、川芎嗪组通畅率分别为92.85%、91.07%、88.67%与低右组81.35%比较差异有统计学意义(P<0.05),治疗组组间比较差异不明显(P>0.05)。⑵丹参、红花、川芎嗪组血管危象发生率与低右组比较差异有统计学意义(P<0.05)。⑶在全血粘度、全血高切、低切、红细胞聚集指数方面,各组在术后第1天、第3天、第7天与基线前后差值组间比较差异均无统计学意义(P>0.05);在血浆粘度方面,除丹参组外,各组在术后第1天、第3天、第7天与基线前后差值组间比较差异均无统计学意义(P>0.05);在红细胞压积方面,除术后第1天的丹参组和川芎嗪组外,各组在术后第1天、第3天、第7天与基线前后差值组间比较差异均无统计学意义(P>0.05)。⑷在纤维蛋白原方面,除术后第1天与第3天的川芎嗪组外,各组在术后第1天、第3天、第7天与基线前后差值组间比较差异均无统计学意义(P>0.05);在凝血酶原时间方面,除术后第3天的川芎嗪组外,各组在术后第1天、第3天、第7天与基线前后差值组间比较差异均无统计学意义(P>0.05)。结论:丹参、红花、川芎嗪注射液在预防显微外科术后血管危象及提高血管通畅率方面比低分子右旋糖酐更有效、更安全,从而提高了手术成功率,降低了肢(指)体坏死率,减少了病人的痛苦,缩短了医疗周期,减少了医疗费用,具有良好的临床应用价值。

Clinical Research of Vascular Crisis after Microsurgery treated by Danshen, Honghua and Chuanxiongqin

Objective： To evaluate the clinical efficacy and safety of Danshen, Honghua and Chuanxiongqin in preventing vascular crisis after small vascular anastomosis. Methods： Two hundred and forty patients who needed microsurgical operation were randomly divided into Danshen group, Honghua group, Chuanxiongqin group and dextran-40 （D-40） group and treated for 10 days. Comparisons were made among vascular pateney rate, incidence of vascular crisis, hemorrheology, and coagulation function, and the potential mechanisms. Results： （1） The average post-operative patency rate was 88. 9%, which indicated that all drugs could effectively prevent vascular crisis. In the three treatment groups, the patency rate was 92.85%, 91.07%, and 88.67%, respectively, while in D-40 group, the patency rate was 81.35%. There was significant difference in post-operative patency rate between D-40 group and the three treatment groups （P〈0.05）. （2） Remarkable difference was found in vascular crisis rate between the three treatment group and D-40 group （P〈0.05）. （3） In the aspects of whole blood viscosity, high shear, low shear, and erythrocyte aggregation, there was no significant difference among all groups on the 1st, 3rd, and 7th day after surgery （P〉 0. 05）. There was significant difference in plasma viscosity compared between Danshen group and other groups on the 1st, 3rd, and 7th day after surgery （P〈0. 05）. In hematocrit, there was significant difference on the 1st day in Danshen group and Chuanxiongqin group compared with other groups （P〈 0. 05）. （4） Significant difference was observed in fibrinogen on the 1st and 3rd day after the operation in Chuanxiongqin group as compared with other groups （P〈0.05）. In prothrombin time, there was significant difference on the 3rd day in Chuanxiongqin group after the operation compared with other groups （P〈0.05）. Conclusion： Danshen, Honghua and Chuanxiongqin injections are more effective and safer in preventing vascular crisis and promoting patency rate than D-40 in post-microsurgery.