微血管吻合器修复腕部桡动脉损伤后 血流动力学分析

Hemodynamic analysis of radial artery injury reconstructed with microvascular anastomotic device

摘要:

目的 探讨微血管吻合器在桡动脉损伤修复中对血流动力学的影响，并评价其应用价值。 方法 选取2012 年12 月-2015 年1 月沈阳医学院附属中心医院手外科收治的桡动脉损伤患者74 例，依据吻合 方式的不同随机分为对照组（显微镜下手法吻合）和观察组（微血管吻合器进行吻合），每组各37 例，进行前瞻 性病例对照研究。对比动脉吻合时长，并采用彩色多普勒检测术后15 天、1 个月及3 个月3 个时间点的血流动 力学参数。结果 观察组动脉吻合时长低于对照组（P <0.05）。术后彩色多普勒随访显示，收缩期峰速度（PSV） 和舒张末期速度（EDV）在对照组和观察组3 个时间点呈升高趋势，搏动指数（PI）呈下降趋势，但组内比较 差异无统计学意义（P >0.05）。观察组PSV 在3 个时间点均高于对照组（P <0.05），EDV、血管内径（D）及血 管横截面积（Area）在术后15 天和术后3 个月时观察组高于对照组。阻力指数（RI）在两组中3 个时间点呈下 降趋势，对照组在术后15 天和术后3 个月时差异有统计学意义（P <0.05），观察组RI 在术后15 天与对照组比 较，差异有统计学意义（P <0.05），观察组低于对照组。D 在对照组术后15 天为最小值，术后1 个月为最大值， 在观察组术后1 个月为最大值，术后3 个月为最小值，差异无统计学意义（P >0.05）。Area 在两组中术后1 个月 为最大值，在术后15 天为最小值，差异无统计学意义（P >0.05）。血流量（Q）在两组中术后15 天为最小值， 术后1 个月为最大值，在对照组中差异有统计学意义（P <0.05），在3 个时间点观察组高于对照组（P <0.05）。 结论 应用微血管吻合器修复损伤桡动脉可以缩短手术时间，与显微镜下手法吻合对比，在术后早期即明显改善 桡动脉血流参数，中后期血流效果更为满意。

Abstract:

Objective To discuss the hemodynamic influences in radial artery injury reconstructed with microvascular anastomotic device and evaluate the application value. Methods Seventy-four patients diagnosed as radial artery injury in Central Hospital Affiliated to Shenyang Medical College from December 2012 to January 2015 were divided into a control group (treated with manual suture under microscope) and on observation group (received reconstruction with microvascular anastomotic device), each had 37 cases. Prospective case control study was carried out. Arterial anastomotic time was contrasted. The hemodynamic indexes were detected by Doppler 15 d, 1 and 3 m after operation. Results Compared with the control group, arterial anastomotic time in the observation group was shorter (P < 0.05). The post-operative Doppler showed that peak systolic velocity (PSV) and end-systolic velocity (EDV) were increased, whereas pulse index (PI) was decreased in both groups 15 d, 1 and 3 m after operation, but there were no significant differences from those before operation (P > 0.05). PSV in the observation group was higher than that in the control group 15 d, 1 and 3 m after operation (P < 0.05). EDV, vascular diameter (D) and cross section area (Area) in the observation group were higher than those in the control group 15 d and 3 m after operation (P < 0.05). Resistance index (RI) in both groups was decreased 15 d, 1 and 3 m after operation, the difference was significant in the control group 15 d and 3 m after operation (P < 0.05); and RI in the observation group was lower than the in the control group 15 d after operation (P < 0.05). D was minimal on the 15th d after operation and maximal at 1 m after surgery in the control group, while it was maximal at 1 m after operation and minimal at 3 m after surgery in the observation group, but the differences were not significant (P > 0.05). Area in both groups was maximal at 1 m after operation and minimal on the 15th d after operation, but the differences were not significant (P > 0.05). Blood flow (Q) in both groups was minimal on the 15th d after operation and maximal in 1 m after operation, the difference in the control group was significant (P < 0.05) and Q in the observation group was higher than that in the control group at the three time points (P < 0.05). Conclusions Radial artery injury reconstruction with microvascular anastomotic device can shorten anastomotic time. Compared with manual suture under microscope, microvascular anastomotic device reconstruction may improve the hemodynamic indexes of radial artery in early phase and obtain more satisfactory blood flow in middle and late phase.