摘要
目的调查老年断指再植患者术后血管危象发生现状,并分析其危险因素。方法采用横断面调查与纵向研究结合的方法,通过简单随机抽样法对2021年1月至2023年9月解放军联勤保障部队第九六〇医院收治的126例行断指再植术治疗的老年患者展开调查,在术后当日采用人口学资料调查表及焦虑自评量表、抑郁自评量表对患者的基本资料及不良情绪进行调查,观察术后血管危象发生情况,并以此分为血管危象组与非血管危象组,术后对患者跟踪随访,记录末次随访再植断指功能。采用SPSS 24.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、秩和检验及χ^(2)检验。采用logistic回归分析评估老年断指再植患者术后血管危象的影响因素。结果126例患者在手术当日发放调查问卷,共收回有效问卷121份,有效回收率96.03%。121例行断指再植术治疗的老年患者术后血管危象发生率为25.62%(31/121)。logistic回归分析显示,吸烟史(OR=2.540,95%CI 1.206~5.347)、完全离断(OR=2.782,95%CI 1.383~5.596)、离断平面为末节(OR=3.456,95%CI 1.948~6.130)、断指缺血时间≥10 h(OR=3.071,95%CI 1.622~5.815)、术后红外线热成像仪提示微循环障碍(OR=8.432,95%CI 5.708~12.455)均为老年断指再植患者术后血管危象的危险因素(P<0.05)。血管危象组末次随访再植断指功能明显较非血管危象组更差(P<0.05)。结论老年断指再植患者术后血管危象发生率可能较青壮年患者更高,严重影响患者预后功能恢复,吸烟史及断指离断、缺血严重是血管危象的高危因素,红外线热成像仪能客观评估术区皮温变化,辅助判断术后血管危象发生风险。
Objective To investigate the current status of postoperative vascular crisis in elderly patients with replanted severed fingers and analyze its risk factors.Methods In a cross-sectional survey and longitudinal study,126 elderly patients who underwent replantation of severed fingers in the 960th Hospital of the PLA Joint Logistics Support Force from January 2021 to September 2023 were investigated using simple random sampling method.The demographic data questionnaire,self-rating anxiety scale and self-rating depression scale were used to investigate the basic data and negative emotions of the patients on the day of surgery.The occurrence of postoperative vascular crisis was observed,and the patients were divided into a vascular crisis group and a non-vascular crisis group.SPSS 24.0 was used for statistical analysis.Data comparison between two groups was performed using t test,rank-sum test or χ^(2)test depending on data type.Logistic regression analysis was used to evaluate the influencing factors of postoperative vascular crisis in elderly patients with replanted severed fingers.Results Questionnaires were distributed to 126 patients on the day of surgery,and 121 valid questionnaires were recovered,with an effective recovery rate of 96.03%.The incidence rate of postoperative vascular crisis in 121 elderly patients who underwent replantation of severed fingers was 25.62%(31/121).Logistic regression analysis showed that smoking history(OR=2.540,95%CI 1.206-5.347),complete disconnection(OR=2.782,95%CI 1.383-5.596),disconnection at the distal phalanx(OR=3.456,95%CI 1.948-6.130),ischemic time of the severed finger≥10 h(OR=3.071,95%CI 1.622-5.815),and microcirculation disturbance on postoperative infrared thermography(OR=8.432,95%CI 5.708-12.455)were risk factors of post-operative vascular crisis in elderly patients with replanted severed fingers(P<0.05).The function of replanted fingers in vascular crisis group was significantly worse than that in non-vascular crisis group at the last follow-up(P<0.05).Conclusion The incidence rate of postoperative vascular crisis in elderly patients with replantation of severed fingers may be higher than that in young and middle-aged patients,seriously affecting the prognosis and function recovery of patients.Smoking history,disconnection of the severed finger,and severe ischemia are high risk factors of vascular crisis.Infrared thermography can objectively evaluate the changes in skin temperature in the surgical area and assist in determining the risk of postoperative vascular crisis.
作者
董延晨
程保国
解琛
Dong Yanchen;Cheng Baoguo;Xie Chen(Department of Outpatient,960th Hospital of PLA Joint Logistics Support Force,Jinan 250031,China;Department of Hand Surgery,960th Hospital of PLA Joint Logistics Support Force,Jinan 250031,China)
出处
《中华老年多器官疾病杂志》
2025年第1期41-44,共4页
Chinese Journal of Multiple Organ Diseases in the Elderly
基金
山东省医药卫生科技项目(202304071677)。
关键词
老年人
断指再植术
血管危象
影响因素
红外线热成像仪
aged
replantation of severed fingers
vascular crisis
influencing factors
infrared thermography
作者简介
通信作者:解琛,E-mail:ripplitxie@163.com。
