临时血液导流管在离断肢体损伤中的实验研究和临床应用  

The experimental study and clinical application of temporary intravascular catheter in treating amputated limb

作　　者：张建磊[1] 丛锐[1] 陈永祥[1] 臧成五[1] 赵睿[1] 史林[1] 

机构地区：[1]第四军医大学西京骨科医院手外科,陕西西安710032

出　　处：《实用手外科杂志》2017年第1期7-11,15,共6页Journal of Practical Hand Surgery

基　　金：国家自然科学基金项目（项目编号：81501064）

摘　　要：目的 探讨血液导流管在离断肢体损伤中快速救治的应用,研究血液导流管制备材料以及短时间内血液导流管维持通血效果的评价.方法 40只实验幼猪随机分为A,B两组,制成后肢完全离断模型.采用内径为2.0 mm、外径2.5 mm、长度18.0 cm,A组肝素化聚乙烯管和B组医用硅胶管桥接于血管断端.术后定期观察血液导流管通畅性,观察终点为血液导流管完全堵塞,血管超声探测仪无血流信号,远端血管搏动消失,离断肢体以远皮下毛细血管网无渗血.比较两组到达观察终点的时间有无差异.临床应用：用肝素化聚乙烯为材料的临时血液导流管（规格2.0 mm×2.5 mm）为2例前臂完全离断的患者桥接离断的桡动脉及头静脉断端,形成临时血管通路,观察血液导流管的临床使用效果.结果 实验用猪肢体离断模型,建立临时血管通路后,离断肢体远端股动脉的远端有搏动,血管超声探测仪可检测到血液导流管内有血流信号,随着时间的延长,血液导流管动脉段逐渐由鲜红色变为暗红色,导流管段逐渐形成附壁血栓,远端血管搏动及皮下毛细管网渗血逐渐减弱直至消失,血流信号消失,AB两组到达观测终点的时间分别为（370.0±52.5）min和（192.0±54.0）min,两者比较其差异有统计学意义（P〈0.05）,说明用肝素化聚乙烯管作为临时血液导流管优于医用硅胶管.临床行桡动静脉临时血管桥接2例,术前准备阶段先进行血液导流管的临时桥接,从通血到开始显微技术吻合血管的总计通血时间平均为3.5 h.建立血管临时桥接通血后,肢端血供恢复,取出血液导流管时,血液导流管仍保持通畅,术后远端肢体成活.结论 临时血液导流管能够用于离断肢体损伤血管的临时桥接,维持通血时间可达（370.0±52.5）min,有效通血时间长,实验数据说明其血液相容性、物理特性及抗凝性均适合于离断肢体损伤中的紧急救治.离断损伤�Objective To explore the application of temporary intravascular catheter using on amputated limb in order to quickly recover blood supply, and to study the material of temporary intravascular catheter and the effectiveness evaluation of blood supply within a short time. Methods There were 40 experimental piglets which were divided into groups A and B randomly. They were established to amputated limb model using the small diameter intravascular catheter of inner diameter of 2.0 mm, outside diameter 2.5 mm and length 18cm. Group A was made of Heparinization polyethylene pipe. Group B was Medical silicone tube. To observe the patency rate after vascular bridge connection. The observation endpoints with the temporary intravascular catheter completely blocked were as follow： no blood flow signal on Doppler ultrasound, and no pusle in distal blood vessel, and distal amputated limb without bleeding. Comparing the different time endpoints of two groups. Clinical application： Heparinization polyethylene pipes （2.0 mm ×2.5 mm） were used into two patients with amputated limb injury. It was used to connect radial artery and cephalic vein of the broken ends in order to establish the temporary vascular access and observe the effect. Results After established temporary vascular access, the distal femoral artery of amputated limb started to pulse, and vascular Doppler ultrasound could detect the signal of blood flow. With the extension of time, the color of diameter intravascular catheter changed from red to dark red with the thrombus formation in inner catheter. The pulse of distal vascular were gradually weakened. The exudation of subcutaneous blood capillary net were also disappeared. The time endpoint of two groups were respectively A group （370±52.5 min） and B Group（192±54.0 min）. Compared with the differences between two group, it had statistical significance （P〈0.05）. To show that Heparinization polyethylene pipes was better than Medical silicone tube in experimental animals. 2 cases were used wit

关 键 词：血液导流管 离断肢体损伤 肢体血管离断模型 猪 血管桥接 

分 类 号：R658.106[医药卫生—外科学]