中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (18): 3355-3358.doi: 10.3969/j.issn.1673-8225.2010.18.030

• 器官移植临床实践 clinical practice of organ transplantation • 上一篇    下一篇

随意皮瓣血液灌流与断蒂时机：激光多普勒成像可能评价吗?

姚月明1，邵洪波2，张庆富2，冯建科2，白永强2，王车江2   

  1. 1石家庄心脑血管病医院骨科，河北省石家庄市 050030；2河北医科大学第一医院烧伤整形外科，河北省石家庄市 050031
  • 出版日期:2010-04-30 发布日期:2010-04-30
  • 作者简介:姚月明，男，1972年生，黑龙江省尚志市人，汉族，1999年华北煤炭医学院毕业，主治医师，主要从事骨科及创伤修复方面的研究。 yyming7209@sohu.com
  • 基金资助:

    河北省科技攻关计划资助项目(062761291)，课题名称：随意皮瓣微循环动态变化的临床研究及己酮可可碱对其活力的影响。

Random flap microcirculation and pedicle division timing: Can laser Doppler imaging evaluate them?

Yao Yue-ming1, Shao Hong-bo2, Zhang Qing-fu2, Feng Jian-ke2, Bai Yong-qiang2, Wang Che-jiang2   

  1. 1 Department of Orthopaedics, Cardiocerebral Vascular Diseases Hospital Shijiazhuang, Shijiazhuang  050030, Hebei Province, China; 2 Department of Burns and Plastic Surgery, First Hospital of Hebei Medical University, Shijiazhuang  050031, Hebei Province, China
  • Online:2010-04-30 Published:2010-04-30
  • About author:Yao Yue-ming, Attending physician, Department of Orthopaedics, Cardiocerebral Vascular Diseases Hospital Shijiazhuang, Shijiazhuang 050030, Hebei Province, China yyming7209@sohu.com
  • Supported by:

    the Key Technologies Research & Development Program of Hebei Province, No. 062761291*

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摘要：

背景：随意皮瓣作为创伤修复的一个主要手段，目前应用较为广泛，对其血液循环建立情况也有很多研究，但对随意皮瓣的血流灌注情况进行系统观察、测定的研究较少。另外，断蒂时机的选择也是随意皮瓣研究的热点，但尚未有较成熟的临床检测手段来判定断蒂时机。
目的：通过激光多普勒血液灌流成像仪对临床随意皮瓣微循环进行动态观察，了解皮瓣血流灌注情况，判定最佳断蒂时机。
方法：18例病例分为传统断蒂组和早期断蒂组，观察皮瓣术后即刻、3、7、11、15、19 d、断蒂前、断蒂后即刻、24 h共8至9个时相的皮瓣远端及皮瓣蒂部两点的血液灌流值，进行统计学分析。
结果与结论：传统断蒂组和早期断蒂组皮瓣远端血液灌流值随时间的延长逐渐增高，各时相血液灌流值与皮瓣术后血液灌流值比较差异有显著性意义(P < 0.05)，而断蒂术后此处的血液灌流值再次降低，传统断蒂组断蒂后与皮瓣术后即刻的血液灌流值比较仍有显著性差别(P < 0.05)；早期断蒂组断蒂后即刻血液灌流值与皮瓣术后即刻血液灌流值比较，差异无显著性意义(P > 0.05)，而断蒂后24 h的血液灌流值与皮瓣术后即刻的血液灌流值比较，差异有显著性意义(P < 0.05)；两组皮瓣蒂部血液灌流值变化较小(P > 0.05)；其两者比值在断蒂前达到高峰，断蒂后逐渐降低，在两者比值达到1.2以上时，断蒂较安全。

关键词: 随意皮瓣, 微循环, 血液灌流值, 断蒂时机, 激光多普勒血液灌流成像仪

Abstract:

BACKGROUND: Random flap as a primary means of wound healing, is widely used at present, its blood circulation to establish the situation is also researched a lot, but not yet the system of random skin flap perfusion were observed and measured. In addition, the timing of pedicle division of a pedicle flap random is also a hot topic, but not yet a mature clinical testing method has been discovered to determine the best timing.
OBJECTIVE: By means of laser Doppler blood perfusion imaging, this study was designed to dynamically observe random flap microcirculation, to understand the changes on random flap blood flow, and to determine the best timing of pedicle division.
METHODS: A total of 18 cases were divided into traditional pedicle division group and early pedicle division group. Pedicle flap blood perfusion values were statistically measured immediately after surgery, at 3, 7, 11, 15, and 19 days after surgery, before division, immediately after division, and at 24 hours after pedicle division, 8-9 phases in total.
RESULTS AND CONCLUSION: Distal blood perfusion value was increased with the time prolongation in both groups; while, the blood perfusion in various time phases was significantly different from that after surgery (P < 0.05); but, the blood perfusion was decreased immediately after surgery, which was still significantly compared with traditional pedicle division group (P < 0.05). There was no significant different in blood perfusion between early pedicle division and immediate after surgery of pedicle division (P > 0.05), but there was significant difference between 24 hours after pedicle division and immediate after surgery of pedicle division (P < 0.05). Blood perfusion values were less changed in both groups (P > 0.05). The ratio of both groups peaked before pedicle division and then gradually decreased after pedicle division. The best timing of pedicle division was the ratio of 1.2.

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