断指再植患者术后血管危象危险因素的meta分析

目的　系统评价断指再植术后血管危象的危险因素。方法　检索数据库万方、知网、维普、中国生物医学、Web of Science、PubMed、The Cochrane Library，检索时限为建库至2022年4月30日。由2名研究人员按照纳入和排除标准，独立进行文献筛选、资料提取、文献评价，运用Revman 5.3软件进行危险因素的meta分析，统计结果用比值比（OR）及95%置信区间（CI）表示，异质性检验当P≥0.1且I²<50%时采用固定效应模型，P<0.1和/或I²≥50%，采用随机效应模型进行meta分析。结果　最终纳入9篇文献，共1 728例患者，发生血管危象303例，血管危象发生率为21.26%。meta分析显示，性别（女性）（OR=3.73，95%CI 2.04～6.82，P<0.000 01）、年龄<12岁（OR=4.71，95%CI 3.41～6.50，P<0.000 01）、吸烟史（OR=4.06，95%CI 3.08～5.35，P<0.000 01）、缺血时间>10 h（OR=3.04，95%CI 1.52～6.07，P=0.002）、伤因（挤压撕脱伤）（OR=4.09，95%CI 2.89～5.78，P<0.000 01）、离断平面（末节离断）（OR=4.10，95%CI 3.03～5.54，P<0.000 01）是断指再植术后血管危象的危险因素。结论　断指再植术后血管危象发生率较高，应针对女性、低龄、有吸烟史、缺血时间长、挤压撕脱伤、末节离断等再植患者采取有针对性的预防措施，以减少血管危象的发生，提高断指再植的成活率。

Meta-analysis of risk factors of postoperative vascular crisis inpatients after severed finger replantation

Objective　To systematically evaluate the risk factors of vascular crisis afterreplantation of severed fingers. Methods　The databasesWanfang, CNKI, VIP, China Biomedicine, Web of Science, PubMed, and The CochraneLibrary were searched from their establishment to April 30, 2022. According tothe inclusion and exclusion criteria, two researchers independently screenedthe literatures, extracted the data, and evaluated the literatures. The Revman5.3 software was used for the meta-analysis of risk factors. The results wereexpressed by odds ratio (OR) and 95%confidence interval (CI). When P≥0.1 and I²<50%,the fixed effect model was used for the meta analysis. When P<0.1 and/or I²≥50%, the randomeffect model was used for the meta analysis. Results　A total of 9 literatures were included, including 1 728 patients, and303 patients had vascular crisis, and the incidence of vascular crisis was21.26%. Meta analysis showed that gender (women) (OR=3.73, 95%CI 2.04-6.82, P<0.000 01), age < 12 years (OR=4.71, 95%CI 3.41-6.50, P<0.00001), smoking history (OR=4.06, 95%CI 3.08-5.35, P<0.000 01), ischemic time > 10 hours (OR=3.04, 95%CI 1.52-6.07, P=0.002), cause of injury (crushavulsion injury) (OR=4.09, 95%CI 2.89-5.78, P<0.00001), and dissociation plane (distal segment dissociation)(OR=4.10, 95%CI 3.03-5.54, P<0.00001) were the risk factors of vascular crisis after finger replantation. Conclusions　The incidence ofvascular crisis after replantation of severed fingers is high. Targetedpreventive measures should be taken for replantation patients such as female,young age, smoking history, long ischemic time, crush avulsion injury, anddistal segment disconnection, so as to reduce the incidence of vascular crisisand improve the severed fingers' survival rate after replantation.