大剂量尿激酶在断肢(指)再植溶栓治疗中的临床应用

目的 研究在断肢(指)再植术中,静脉推注尿激酶防治血管危象的效果。方法 1999年9月~2003年10月,对158例断肢(指)再植术中血管缝接后,静推尿激酶60万U;术后小剂量维持用药,每12h用20万U;术后出现血管危象时,用大剂量100万~150万U尿激酶治疗。用药前后监测D-二聚体、纤维蛋白原、血红蛋白、血小板。结果 158例再植术后未出现血管危象117例,有效率74.1%。大剂量尿激酶治疗术后41例血管危象获得解除者37例,仅4例(1例断腕,3例断指)需再次探查,有效率达90.2%。以上结果均高于相关报道。结论 在再植术中用中剂量尿激酶溶栓,术后小剂量间隔用药是可行的,可防止血栓形成;一次性大剂量用药能解救术后出现的血管危象,避免再次手术探查,既安全又有效,具有临床实用价值。

High-dose urokinase for thrombolysis follouing replantation of severed limbs or fingers

Objective To study the efficacy of intravenous urokinase administrationin preventing and treating vascular crisis in limb or finger replantation (LFR). Methods From September, 1999 to October, 2003, 158 patients underwent RSLF in whom 600 000 U of urokinase diluted in 30 ml saline was injected intravenously after blood vessel suture. An intermittent dose (200 000 U) per 12 h given postoperatively for maintenance. A large dose of 1 000 000-1 500 000 U of urokinase was used in the event of vascular crisis. The D-dimer, fibrinogen, hematin, and blood platelet were measured in these patients before and after urokinase administration. Results Vascular crisis was not observed in 117 patients (74.1%) undergoing LFR, and in the 41 patients who developed vascular crisis, relief was achieved by high-dose urokinase (90.2%) with failure occurring in only 4 cases (one with wrist and 3 with finger replantation) for whom re-operation was required. The result was better than those in relevant reports. Conclusion A moderate dose of urokinase can be used after suturing the vessels and intermittent small doses prove feasible postoperatively to prevent thrombosis in RSLF. A high dose of urokinase can be safely used for vascular crisis management in the early stage.