低分子量肝素钠对逆行岛状皮瓣存活影响的实验研究  

The impact of low molecular weight heparin on survival of reverse-flow island flaps： an experimental study in rabbits

作　　者：王欣[1] 张英琪[1] 陈锐[1] 张世民[1] 俞光荣[1] 

机构地区：[1]同济大学附属同济医院骨科,上海200065

出　　处：《中华手外科杂志》2016年第2期138-140,共3页Chinese Journal of Hand Surgery

基　　金：国家自然科学基金资助项目（81201411、81271993）

摘　　要：目的 以新西兰大白兔隐动静脉逆行岛状皮瓣为实验模型,探讨低分子量肝素钠对逆行岛状皮瓣存活的影响及其临床意义.方法 将10只新西兰大白兔随机分为2组,每组5只.其左右两侧后肢各10块皮瓣,进行对照研究.建立隐动静脉逆行岛状皮瓣实验模型（皮瓣面积3 cm×3 cm,血管蒂长4 cm,血管蒂周围保留1 cm宽的筋膜组织）.对照组（A组）：术后不做任何处理;实验组（B组）：术后即刻开始皮下注射低分子量肝素钠200 U/kg,每日1次,共5d.术后每天观察皮瓣颜色、肿胀情况.术后1周测皮瓣成活率.结果 两组皮瓣早期血液循环良好.对照组皮瓣创面渗血停止后,出现明显的肿胀,以皮瓣远端部分最为明显.实验组皮瓣的渗血时间延长,未出现静脉危象,所有皮瓣均存活.术后7d,两组皮瓣平均存活面积比较,对照组为（89.5±15.2）％,实验组为（97.5±5.4）％,差异有统计学意义（P＜0.01）.结论 皮下注射低分子量肝素钠能延长逆行岛状皮瓣创面渗血时间,减轻皮瓣早期静脉回流的负荷,提高皮瓣存活质量.Objective To evaluate the effect of low molecular weight heparin on the survival of reverseflow island flaps.Methods A saphenous vessel reverse-flow island flap model was established on both hind limbs in 10 New Zealand white rabbits that were randomly divided into 2 groups.Each group had 10 flaps.The flap area was 3 cm × 3 cm.The vascular pedicle length was 4 cm,and the width of the fascia reserved around the saphenous vessels was about 1 cm.In group A （control） the rabbits received no treatment after flap elevation and suture.In group B （experiment） 200 IU/kg low molecular weight heparin was administered via subcutaneous injection once a day for 5 days.Flap perfusion and drainage,color and swelling were observed daily for one week when flap survival was evaluated.Results Blood circulation of the flaps was good in the early postoperative stage.After 1 to 2 days,blood oozing from flap edges stopped in group A.The flaps began to appear obviously edematous,and the color of the flaps turned dark purple.In group B,oozing from the edge of the flaps lasted significantly longer.There was no obvious venous congestion or swelling.Seven days after flap elevation,the mean percentage of survival area of the flaps was （89.5 ± 15.2） % in group A and （97.5 ± 5.4） % in group B,respectively.The difference was significant （P 〈 0.01）.Conclusion The application of low molecular weight heparin via subcutaneous injection can improve microcirculation within the flap and increase the quality of flap survival by releasing the load of venous congestion through prolonged oozing from flap edges.

关 键 词：外科皮瓣 动物实验 静脉回流 低分子量肝素钠 

分 类 号：R622[医药卫生—整形外科]