断指再植术后那屈肝素钙局部注射的疗效及对凝血功能的影响

目的 探讨那屈肝素钙局部注射应用于断指再植术后的疗效，及其对凝血功能的影响。 方法 选择2016年2月—2018年9月期间在宁波市第一医院进行治疗的46例(62指)断指再植患者，随机数表法分成实验组(23例)和对照组(23例)，对照组在脐周皮下注射那屈肝素钙，实验组给予局部皮下注射那屈肝素钙，比较2组患者术后1 d、5 d、7 d的肿胀直径和疼痛视觉模拟(VAS)评分，术后发生静脉血栓、血管痉挛、再植体坏死等并发症发生率以及治疗前后的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)及纤维蛋白原(FIB)等凝血功能指标。 结果 2组术后5 d、7 d的肿胀直径均显著低于治疗前(P<0.05)，实验组患者术后5 d、7 d的指体肿胀程度均低于对照组；实验组术后1 d、5 d、7 d的VAS评分均低于对应时间点对照组患者的VAS评分，差异具统计学意义(均P<0.05)；实验组患者静脉并发症和并发症总发生率均显著低于对照组(P<0.05)。对照组治疗后PT、APTT和TT明显升高(均P<0.05)，实验组治疗前后的PT、APTT和TT及FIB差异无统计学意义(均P>0.05)，对照组治疗后PT、APTT和TT明显高于实验组(均P<0.05)，2组治疗前后的FIB差异无统计学意义(P>0.05)。 结论 那屈肝素钙局部注射治疗断指再植术后的效果较好，能显著减少并发症发生率，且对凝血功能影响较小。 

Efficacy of subcutaneous injection of Nadroparin calcium after replantation of digits on venous congestion of patients and complications

Objective To investigate the efficacy of subcutaneous injection of Nadroparin calcium after replantation of digits on venous congestion of patients and complications. Methods Forty six patients (62 fingers) undergoing replantation of digits in our hospital between February 2016 and September 2018 were enrolled and divided into experimental group (23 cases) and control group (23 cases) by random number table method. Nadroparin calcium was injected subcutaneously on the right or left side of the abdominal wall in the control group and on the replanted fingers in the experimental group. The swelling diameter and pain visual analogue scores (VAS) at 1 d, 5 d and 7 d after the surgery were compared between the two groups. The incidence of complications such as embolism, vasospasm and skin flap necrosis was compared. The levels of prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin time (thrombin time, TT), fibrinogen (Fibrinogen, FIB) and other coagulation indicators were compared between the two groups before and after treatment. Results The swelling diameter of the two groups at each time point was significantly lower than that before the treatment (P<0.05). Among them, the degree of swelling of the fingers in the experimental group was lower than that of the control group at 5 d and 7 d after the operation. VAS scores at 1 d, 5 d and 7 d of the experimental group were lower than those of the control group at the corresponding time points, and the difference was statistically significant (all P<0.05). The incidence of venous and total complications were significantly lower in the group than in the control group (all P<0.05). After the treatment, the levels of PT, APTT and TT in the control group increased significantly (all P<0.05). There was no significant difference in PT, APTT, TT and FIB in the experimental group before and after the treatment (all P>0.05). After the treatment, PT, APTT and TT in the control group were significantly higher than those in the experimental group (all P<0.05). There was no significant difference in FIB between the two groups before and after treatment (P>0.05). Conclusion Low-molecular-weight heparin calcium subcutaneous injection is effective in the treatment of venous congestion after replantation of severed fingers, which can significantly reduce the incidence of complications and has little effect on coagulation.