指尖血糖监测判断断指再植术后指体血运的临床效果  

Analysis of the effect of fingertip blood glucose monitoring on finger blood supply after replantation of severed fingers

作　　者：刘雄华 朱细娇 冯运垒 周冠冠 李雪梅 郭伟军 LIU Xionghua;ZHU Xijiao;FENG Yunlei(Department of Hand and Foot Surgery,Yangjiang Fraternity Hospital,Yangjiang,Guangdong,529500,China)

机构地区：[1]阳江博爱医院手足外科,广东阳江529500

出　　处：《实用手外科杂志》2022年第2期164-166,172,共4页Journal of Practical Hand Surgery

基　　金：广东省阳江市卫生类科技计划项目(项目编号:SF2020133)。

摘　　要：目的 探讨通过监测指尖血糖判断断指再植术后再植指体血运变化的临床效果。方法 回顾性分析2020年1月-2021年6月收治的断指再植患者115例,术后观察再植指体血运变化,其中采用传统判断方法(对照组)55例64指,采用指尖血糖判断法(观察组)60例79指。对照组采用传统经验判断,即根据再植体颜色、渗血判断血运状况。观察组采用指尖血糖变化判断再植体血运。血糖监测自术后开始每2小时测量一次,监测部位为指尖,测量完成后于床头记录血糖数值。再植体成活血糖阈值定位3 mmol/L,一旦指尖血糖监测数值接近3 mmol/L,无论指体颜色、饱满度、渗血有无改变,立即行急诊手术探查。结果 对照组中,64指术后共10指出现血运不良情况,根据经验判断发生血管危象并进行探查2指,3指予及时换药拆线对症治疗,术后共成活5指,未被及时准确判断而造成指体坏死5指,准确率为50%。观察组中,79指术后共12指出现血运欠佳,血糖到达阈值而进行探查8指,其余4指给予换药拆线对症处理,术后共成活10指,坏死2指,准确率为83%,两组对比,差异有统计学意义。对照组64指中5指发生坏死,其总成活率为92.2%,观察组79指中2指发生坏死,其成活率为97.4%。两组间成活率比较差异有统计学意义,且观察组远高于对照组。结论 监测断指再植术后指尖血糖变化可准确判断再植指体血运变化情况,做到及时预判,且无需特殊器械,值得临床推广应用。Objective To investigate the clinical effect of monitoring the blood glucose level after replantation to judge the blood supply changes of replanted finger. Methods A total of 115 patients with amputated fingertips who were admitted to our department from January 2019 to January 2021 were reviewed. Among them, 55 cases were judged by traditional method(control group) and 60 people were judged by fingertip blood glucose method(experimental group). In the control group, the traditional experience judgment method was used, that was, the blood supply status of the severed finger was judged by the senior physician in the group during the morning and evening rounds according to the color of the replantation and the oozing blood during the rest of the week, and the blood supply of the severed finger was checked by the senior nurse every 4 hours. In the experimental group, the blood flow in the replant was determined by the change of blood glucose in the fingertip. Blood glucose monitoring was performed by senior nurses, and the monitoring time was measured every 2 hours from the beginning of the operation. The monitoring site was the fingertip. After the measurement was completed, the blood glucose value was recorded at the head of the bed. The survival blood glucose threshold of the replanters was set at 3 mmol/L. Once the fingertip blood glucose monitoring value approached 3 mmol/L, emergency surgical exploration was conducted immediately, regardless of the color of the finger body, plumpness and ooziness. Results In the control group, a total of 10 cases of poor blood circulation occurred after finger amputation in 64 cases. According to experience, vascular crisis was diagnosed and explored in 2 cases, and all survived after surgery. 8 cases of bad fingers were caused by not being timely and accurately judged, with an accuracy rate of 20%. In the experimental group, a total of 12cases of 79 cases showed poor blood circulation after finger amputation, and 8 cases were investigated after blood glucose reached the thre

关 键 词：断指再植 血糖监测 血运变化 准确性 

分 类 号：R658.1[医药卫生—外科学]