断指再植术后肝素抗凝治疗的风险评估

目的:探讨断指再植术后肝素抗凝治疗的风险评估.方法:选取2014年6月-2016年6月在医院接受治疗的120例断指再植手术患者作为此次研究对象,并将其随机分为观察组与对照组,每组患者60例,给予两组患者术后连续使用肝素治疗,对照组患者连续使用10天时间,观察组患者连续使用2天时间,分析比较两组患者血管危象发生率、手指成活率和活化部分凝血活酶时间(APTT)情况.结果:观察组患者发生血管危象6例,占比10%,对照组患者发生血管危象5例,占比8.3%,两组患者血管危象发生率差异极小,组间比较无统计学意义(P>0.05);观察组患者断指再植成活57例,占比95%,对照组患者断指再植成活56例,占比93.3%,两组患者断指再植成活率差异极小,组间比较无统计学意义(P>0.05);术前和术后2d,两组患者的APTT变化情况差异不大,组间比较无统计学意义(P>0.05);术后2d,两组患者APTT稍高于术前,差异不明显无统计学意义(P>0.05);术后10d,观察组患者APTT恢复至术前水平,对照组患者APTT则明显升高,两组之间差异较大,组间比较具有统计学意义(P<0.05).结论:断指再植术后肝素抗凝治疗患者,血管危象和再植成功率与连续使用肝素时间没有多大区别,使用时间越长,APTT反而会延长,临床上应予以关注.

Risk assessment of anticoagulant therapy with heparin after finger replantation

Objective: To evaluate the risk of heparin anticoagulation after replantation of amputated finger.Methods: 120 patients with replantation of amputated finger were treated in our hospital from June, 2014 to June, 2016.The patients were randomly divided into observation group and control group, 60 cases in each group, The patients in the control group were treated with heparin continuously for 10 days.The patients in the observation group were used for 2 consecutive days.The incidence of vascular crisis, survival rate of fingers and activated partial thromboplastin time APTT).Results: In the observation group, there were 6 cases of vascular crisis, accounting for 10%, and 5 cases of vascular crisis occurred in the control group, accounting for 8.3%.There was no significant difference in the incidence of vascular crisis between the two groups (P> 0.05).In the observation group, there were 57 replantation replicates, accounting for 95% of the replantation replantation in the control group and 56.3% in the control group, 93.3% of the replantation replicates survived in the two groups (P> 0.05).There was no significant difference in APTT between the two groups (P> 0.05).At 2 days after operation, there was no significant difference between the two groups (P> 0.05) APTT in the two groups was slightly higher than that before operation, the difference was not significant (P> 0.05).On the 10th day after operation, APTT returned to preoperative level in the observation group and APTT in the control group increased significantly The differences were significant (P<0.05).Conclusion: The success rate of heparin anticoagulation therapy after amputated finger replantation is not different from that of continuous use of heparin.The longer the use time, the longer the APTT will be, and the clinical attention should be paid to it.