本文選題：激光散斑　切入點(diǎn)：斷指再植　出處：《山東大學(xué)》2017年碩士論文

【摘要】：目的:使用激光散斑對(duì)比分析技術(shù)監(jiān)測(cè)斷指再植患者術(shù)后再植指皮層血流灌注情況,探討斷指再植術(shù)后再植手指早期微循環(huán)灌注的特點(diǎn)及規(guī)律,建立斷指再植術(shù)后激光散斑對(duì)比分析技術(shù)測(cè)量再植指血液灌注量的參考值范圍,并對(duì)不同動(dòng)脈吻合數(shù)量和不同致傷原因患者的術(shù)后灌注量進(jìn)行比較,為護(hù)理人員觀察判斷血運(yùn)變化提供客觀依據(jù)。方法:2016年4月1日至9月30日,152例患者進(jìn)行斷指再植手術(shù)治療的患者,術(shù)后血運(yùn)良好,男性患者112例,女性患者40例,平均年齡34.92±15.11歲。單指再植116例,雙指再植32例,三指再植4例,再植指總共192根,術(shù)中吻合單支動(dòng)脈再植60根手指,雙支動(dòng)脈132根手指。切割傷患者52例,斷指72根,擠壓傷患者100例,斷指120根。分別按照吻合動(dòng)脈數(shù)量和致傷原因?qū)⒒颊叻纸M。采用PeriCam PSI System分別在術(shù)后第1～7天采集再植指血流灌注量及同患者對(duì)側(cè)相應(yīng)正常手指灌注量數(shù)據(jù),數(shù)據(jù)以灌注量單位的形式表達(dá)。用統(tǒng)計(jì)學(xué)軟件對(duì)數(shù)據(jù)進(jìn)行分析。結(jié)果:再植指術(shù)后第1～7天灌注量分別為88.46±42.27、111.73±55.80、117.47±48.43、116.92±54.99、107.34±47.88、112.26±52.78、111.95±50.28。正常手指灌注量為180.11±25.71。術(shù)后第1～7天灌注量95%置信區(qū)間分別為73.47～103.45、94.12～129.34、102.38～132.56、100.00～133.85、91.82～122.86、94.40～130.12、93.50～130.39,正常手指灌注量95%置信區(qū)間為 167.32～190.89。術(shù)后第1天灌注量顯著低于術(shù)后第2～4天、第6～7天,有統(tǒng)計(jì)學(xué)意義。第2～7天再植指灌注量對(duì)比沒(méi)有統(tǒng)計(jì)學(xué)差異。術(shù)后第1～7天每日再植指血液灌注量顯著低于正常手指,有統(tǒng)計(jì)學(xué)意義。吻合2支動(dòng)脈的再植指在術(shù)后第1～4天、第6～7天灌注量均高于吻合1支動(dòng)脈的再植指,僅術(shù)后第5天低于吻合1支動(dòng)脈的再植指,每日兩組再植指血流灌注量差異沒(méi)有統(tǒng)計(jì)學(xué)意義。擠壓傷再植指在術(shù)后第1～2天、第4～7天灌注量均高于切割傷再植指,僅術(shù)后第3天低于切割傷再植指,每日兩組再植指血流灌注量差異沒(méi)有統(tǒng)計(jì)學(xué)意義。結(jié)論:激光散斑對(duì)比分析技術(shù)具有非接觸、無(wú)創(chuàng)傷、快速成像等優(yōu)點(diǎn),非常適用于微循環(huán)血流的測(cè)量。臨床用于監(jiān)測(cè)再植手指皮層血液微循環(huán)較有價(jià)值,為護(hù)理人員觀察判斷血運(yùn)變化提供了客觀依據(jù)。經(jīng)灌注量測(cè)定分析,對(duì)于斷指再植術(shù)后病情平穩(wěn),血循環(huán)恢復(fù)順利的患者,再植指術(shù)后第1天血流灌注最差,第2～7天相對(duì)平穩(wěn),且較第1天明顯增加,有統(tǒng)計(jì)學(xué)意義;術(shù)后第1～7天再植指灌注量不穩(wěn)定,有比較大的波動(dòng),與正常手指相比有較大差距,具有統(tǒng)計(jì)學(xué)意義。手術(shù)中吻合2支動(dòng)脈可以提高灌注量,但與吻合1支動(dòng)脈相比,并沒(méi)有統(tǒng)計(jì)學(xué)意義。吻合動(dòng)脈數(shù)量的增加不能顯著得提高灌注,不是再植指成活的決定因素,動(dòng)靜脈吻合的比例與吻合質(zhì)量更加關(guān)鍵。只要斷指具備再植指征,經(jīng)過(guò)良好的手術(shù)處理,致傷原因可能并不影響再植指術(shù)后血流灌注量。
[Abstract]:Objective: to investigate the characteristics and regularity of early microcirculation perfusion of replanted finger after replantation of finger by using laser speckle contrast analysis technique to monitor the blood flow perfusion in the cortex of replanted finger after replantation of severed finger.The reference range of blood perfusion of replanted finger was measured by laser speckle analysis after replantation, and the postoperative perfusion of patients with different arterial anastomosis and different injury cause was compared.To provide objective basis for nursing staff to observe and judge the changes of blood circulation.Methods: from April 1 to September 30, 2016, 152 patients underwent replantation of severed fingers. The blood flow was good after operation. 112 male patients and 40 female patients with average age of 34.92 鹵15.11 years.There were 116 cases of single finger replantation, 32 cases of double finger replantation, 4 cases of 3 finger replantation, 192 replanted fingers. 60 fingers were replanted by single branch artery and 132 fingers were replanted by double branch artery during operation.52 cases were incised, 72 fingers were amputated, 100 cases were crush injury, 120 fingers were amputated.Patients were divided according to the number of anastomotic arteries and the causes of injury.PeriCam PSI System was used to collect the blood flow volume of replanted finger and the corresponding normal finger perfusion data from the contralateral side of the same patient on the 1st day after operation. The data were expressed in the form of perfusion volume units.Statistical software was used to analyze the data.Results: the perfusion volume was 88.46 鹵42.27111.73 鹵55.80117.47 鹵48.43116.92 鹵54.99107.34 鹵47.88112.26 鹵52.78111.95 鹵50.28on the 1st day after replantation.The normal finger perfusion was 180.11 鹵25.71.The 95% confidence interval of perfusion volume on the 1st day after operation was 73.47 / 103.45 / 94.129.34102.38 / 132.560.001 / 133.85 / 91.82 / 91.82 / 94.40 / 130.120.120.120.120.50 / 93.50 / 130.39, respectively, and the 95% confidence interval of normal finger perfusion was 167.32 / 190.89.The perfusion volume on the first day after operation was significantly lower than that on the 2nd day and 6th day.On the 2nd day, there was no statistical difference in the volume of replantation finger perfusion.The daily blood perfusion of replanted fingers was significantly lower than that of normal fingers on the 1st day after operation.The perfusion volume of the replanted fingers of the two branches was higher than that of the replanted fingers of the anastomosed artery on the 1st day and the 6th day after operation, and was lower than that of the replanted fingers of the anastomosed artery on the 5th day after operation.There was no significant difference in blood perfusion between the two groups.The perfusion volume of the replanted finger was higher than that of the replanted finger on the 1st and 7th day after operation, but on the third day after operation, it was lower than that on the third day after operation. There was no significant difference between the two groups in the blood flow perfusion of the replanted finger every day.Conclusion: laser speckle contrast analysis has the advantages of non-contact, non-invasive and fast imaging, so it is very suitable for the measurement of blood flow of microcirculation.It is valuable to monitor the blood microcirculation of the replanted finger cortex and provide objective basis for nursing staff to observe and judge the changes of blood circulation.For the patients with stable condition and smooth blood circulation recovery after replantation of severed fingers, the perfusion was the worst on the first day after replantation, and relatively stable on the 2nd and 7th day, which was significantly higher than that on the first day.The perfusion volume of replanted fingers was unstable and fluctuated on the 1st day after operation, which was significantly different from that of normal fingers.Anastomosis of two branches increased the perfusion volume, but there was no statistical significance compared with the anastomosis of 1 branch artery.The increase in the number of anastomotic arteries can not significantly improve the perfusion and is not the decisive factor for the survival of replanted fingers. The proportion of arteriovenous anastomosis and the quality of anastomosis are more critical.As long as the finger replantation indication is available and the surgical treatment is good, the cause of injury may not affect the blood flow volume after replantation.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.6

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