前列地尔对皮瓣移植患者术后凝血系统的影响

目的探讨前列地尔对游离皮瓣移植患者术后凝血系统的影响。方法将哈尔滨市第五医院2012年2月~2014年8月收治的200例四肢游离皮瓣移植术后患者纳入观察范围,根据随机原则分为常规治疗组与前列地尔组,每组各100例。常规治疗组使用低分子右旋糖酐、肝素以扩容、抗凝,前列地尔组在常规治疗的基础上于手术当天给予前列地尔注射液(曼新妥,10μg溶于100m L生理盐水)静脉点滴,连续7d。观察患者术后24、72h皮瓣肿胀程度、疼痛评分、患者术后凝血功能检测及72h血管危象发生率。结果前列地尔组术后24h和72h的皮瓣肿胀程度评分、术后72h疼痛评分明显低于常规治疗组(P0.05);前列地尔组术后72h血管危象发生率(1.0%)明显低于常规治疗组发生率(5.71%,P=0.02);两组患者术后同一时间点,凝血各项指标的检测结果比较,差异无显著性(P=1.18)。结论游离皮瓣移植术后应用前列地尔能有效维持皮瓣移植患者术后凝血系统的稳定,抑制血小板聚集,防止肢体肿胀与减轻疼痛,减少血管危象的发生,具有临床应用价值。

Effects of Alprostadil on coagulation system in patients undergoing skin flap transplantation

Objective To investigate the effects of Alprostadil at different time points on coagulation system in patients undergoing skin flap transplantation.Methods Two-hundred patients undergoing free skin flap trans-plantation from Feb.2012 to Aug.2014 in our department were selected and equally divided into conventional treat-ment group and Alprostadil group.Patients in the conventional group were treated with low molecular dextran and heparin for expansion and anticoagulation.Patients in the Alprostadil group were added with intravenous injection of Alprostadil on the basis of conventional treatment from the day of surgery for 7d.The turgidity of skin flap,pain score,vascular crisis occurrence,and determination of coagulation function in patients were observed at 24h and 72h after surgery.Results The turgidity of skin flap in the Alprostadil group was significantly lower than that of the conventional group at 24h and 72h after surgery(P<0.05).The pain score in the Alprostadil group was signifi-cantly lower than that of the conventional group at 72h after surgery(P<0.05).The vascular crisis occurrence rate in the Alprostadil group and the conventional group was 1.0% and 5.71%,respectively at 72h after surgery.The vascular crisis incurrence rate in the Alprostadil group was significantly lower than that of the conventional group at 72h after surgery(P =0.02).The coagulation function index showed no significant difference between the two groups at the same time point(P=1.18).Conclusion The administration of Alprostadil after free skin flap trans-plantation can keep the stability of coagulation system in patients,inhibit the aggregation of platelets,prevent the tur-gidity and pain,reduce the vascular crisis incurrence rate and have good clinical application values.