目的 探讨小剂量肝素对断指再植术后患者血液流变学及肝功能的影响.方法 回顾性分析2020年1月-2021年10月行断指再植术60例(64指)患者的临床资料,将其随机分为半量组30例(31指)和全量组30例(33指).半量组予6 250 U肝素钠持续微泵静滴,全量组予12 500 U肝素钠持续微泵静滴.比较两组断指再植成活情况以及血管危象发生情况;比较治疗前后两组血液流变指标、凝血功能以及肝功能水平.结果 两组断指成活率及血管危象发生率差异无统计学意义(P＞0.05);治疗后两组红细胞沉降率以及血细胞比容较治疗前均有降低,组间差异无统计学意义(P＞0.05);半量组治疗后凝血酶时间、活化部分凝血活酶时间、凝血酶原时间、谷丙转氨酶以及谷草转氨酶水平与治疗前差异无统计学意义(P＞0.05),且上述指标水平均低于全量组(P＜0.05).结论 小剂量肝素可帮助改善断指再植术后局部血液循环,改善血液流变学水平,降低血管危象风险,提升断指成活率,同时相较于常规剂量而言,其对患者机体凝血功能和肝功能水平的影响更小.

Objective To explore clinical effects of large decompressive craniectomy by pterion-temple approach (P-TA) for treatment of indicative massive cerebral infarction. Methods A total of 34 cases who underwent decompression by standard craniectomy or P-TA craniectomy for treating massive cerebral infarction between 2006 and 2008 were reviewed and analyzed retrospectively. The curative effect was evaluated according to Barthel Index (BAI) and Glasgow Outcome Score (GOS). Results The ratios of bulged brain tissue volume of two groups 1 d after operation were significantly different (t=2.788,P0.05). All patients were followed-up after operation. There was no significant difference in the mortality of two groups 3 and 6 months after operation (P0.05); however,there was significant difference in the BAI and GOS of two groups 3 and 6 months after operation (t=7.329,4.076,8.734,3.818; P0.05). Conclusion Decompressive craniectomy via P-TA has the advantages of easy operating and sufficient exposure and decompression. It is a good option for the treatment of indicative massive cerebral infarction.