刘建芳 庄智勇

【摘要】 目的：探究自擬活血扶正汤在断指再植术后血管危象中的预防效果。方法：研究对象为2016年1月-2019年1月于笔者所在医院进行断指再植术的60例外伤性手指离断伤患者，按照随机原则将所有患者分为对照组（n=30，术后给予常规三抗治疗）与观察组（n=30，术后在常规治疗的基础上口服自拟活血扶正汤）。应用疼痛视觉模拟评分法（VAS）评价两组术后24 h和治疗7 d后疼痛情况;随访3个月，比较两组治疗优良率、血管危象发生率及再植指成活率。结果：治疗7 d后，两组VAS评分均较术后24 h降低，观察组下降幅度明显优于对照组，差异有统计学意义（P<0.05）;随访3个月，观察组治疗优良率为86.67%，明显高于对照组的63.33%，差异有统计学意义（P<0.05）;随访3个月，观察组再植指成活率高于对照组，血管危象发生率低于对照组，差异均有统计学意义（P<0.05）。结论：在常规治疗基础上，将自拟活血扶正汤应用于断指再植术后血管危象预防中效果更显著，有利于缓解患者疼痛感，预防血管危象发生，促进再植指成活。

【关键词】 断指再植术 自拟活血扶正汤 血管危象 再植指成活率

doi：10.14033/j.cnki.cfmr.2019.28.016 文献标识码 B 文章编号 1674-6805（2019）28-00-03

Preventive Effect of Self-made Huoxue Fuzheng Decoction on Vascular Crisis after Replantation of Severed Finger/LIU Jianfang， ZHUANG Zhiyong. //Chinese and Foreign Medical Research， 2019， 17（28）： -41

[Abstract] Objective： To explore the preventive effect of self-made Huoxue Fuzheng Decoction on vascular crisis after replantation of severed finger. Method： The study subjects were 60 patients with traumatic finger mutilation， who were treated with replantation of severed finger in the hospital of the author from January 2016 to January 2019， and patients were randomly divided into the control group （n=30， given routine triple antibody therapy after operation） and the observation group （n=30， taking self-made Huoxue Fuzheng Decoction after operation on the basis of routine treatment）. Visual analogue scale （VAS） was used to evaluate the pain 24 hours after operation and 7 days after treatment in the two groups. Followed up for 3 months， the excellent and good rate of treatment， the incidence of vascular crisis and the survival rate of replanted finger were compared between the two groups. Result： After 7 days of treatment， the VAS scores of both groups were lower than those of 24 hours after operation， and the decline of the observation group was significantly better than that of the control group， and the differences were statistically significant （P<0.05）. Followed up for 3 months， the excellent and good rate of the observation group was 86.67%， which was significantly higher than 63.33% of the control group， and the difference was significant （P<0.05）. Following up for 3 months， the survival rate of replanted fingers in the observation group was higher than that of the control group， and the incidence of vascular crisis was lower than that of the control group， and the differences were significant （P<0.05）. Conclusion： On the basis of routine treatment， self-made Huoxue Fuzheng Decoction is more effective in the prevention of vascular crisis after replantation of severed finger， which is conducive to alleviating pain， preventing vascular crisis and promoting the survival of replanted fingers.

[Key words] Replantation of severed finger Self-made Huoxue Fuzheng Decoction Vascular crisis Survival rate of replanted finger

First-authors address： Quanzhou Orthopedic-traumatological Hospital， Quanzhou 362000， China

断指再植术是临床治疗自残性外伤或意外性外伤所致断指的重要手段，可最大程度帮助患者修复手指原有的形态及功能，手术难度极大[1]。随着显微镜技术的不断发展，断指再植术的成功率也有所升高，但影响患者术后康复的因素却并未减少。多数患者由于再植血管循环功能重建效果不佳，导致血液黏度升高且血管痉挛栓塞，极易引发血管危象症状，降低再植指成活率[2]。因此，对断指再植术后患者的辅助治疗极为重要。目前，临床通常采用抗凝、抗感染、抗血管痉挛等常规“三抗”药物作为预防断指再植术后血管危象发生的治疗手段，但仍有部分患者术后发生静脉危象，影响再植指的成活率[3]。本次研究中，通过对2016年1月-2019年1月在笔者所在医院进行断指再植术的60例外伤性手指离断伤患者采取自拟活血扶正汤辅助治疗，获得较为满意的效果，将结果报道如下。……