摘要
目的 探讨血液生化指标与游离皮瓣部分坏死的关系,筛选影响游离皮瓣部分坏死的血液生化因素,为提升游离皮瓣的成活率提供有效指标.方法 采用回顾性调查研究分析,自2018年2月至2023年5月在我院创伤骨科采用游离股前外侧皮瓣修复四肢缺损创面60例,对术前PT值、纤维蛋白原、血红蛋白、甘油三酯、低密度脂蛋白、空腹血糖、餐后2 h血糖、白蛋白、前白蛋白、球蛋白、总蛋白、D-二聚体检测数值进行记录与分析.筛选出具有统计学意义的生化因素,进一步行多因素Logistic回归分析.结果 纤维蛋白原、血红蛋白、低密度脂蛋白、空腹血糖、餐后2 h血糖、白蛋白、D-二聚体为游离皮瓣部分坏死的危险因素(P＜0.05).纳入多因素Logistic分析,纤维蛋白原、低密度脂蛋白、空腹血糖、餐后2 h血糖、D-二聚体与游离皮瓣部分坏死呈正相关;血红蛋白、白蛋白与游离皮瓣部分坏死呈负相关.结论 纤维蛋白原较高、血红蛋白较低、低密度脂蛋白较高、空腹血糖较高、餐后2 h血糖较高、白蛋白较低、D-二聚体较高时,需要警惕术后出现游离皮瓣部分坏死的可能,术前予相应调节,避免游离皮瓣部分坏死的出现.
Abstract
Objective To explore the relationship between blood biochemical indicators and partial necrosis of free flaps,screen for blood biochemical factors that affect partial necrosis of free flaps,and provide effective indicators for improving the survival rate of free flaps.Methods A retrospective survey was conducted and analyzed.From February 2018 to May 2023,60 cases of limb defect wounds were repaired using a free anterolateral femoral flap in the Department of Traumatology and Orthopedics at our hospital.The preoperative PT values,fibrinogen,hemoglobin,triglycerides,low-density lipoprotein,fasting blood glucose,2-hour postprandial blood glucose,albumin,prealbumin,globulin,total protein,and D-dimer detection values were recorded and analyzed.The biochemical factors with statistical significance were screened out and further multivariate logistic regression analysis was conducted.Results The fibrinogen,hemoglobin,low-density lipoprotein,fasting blood glucose,2-hour postprandial blood glucose,albumin,and D-dimer were risk factors for partial necrosis of free flaps(P＜0.05).Through multivariate logistic regression analysis,the fibrinogen,low-density lipoprotein,fasting blood glucose,2-hour postprandial blood glucose,D-dimer were positively correlated with partial necrosis of free flaps.The hemoglobin and albumin were negatively correlated with partial necrosis of free flaps.Conclusion When fibrinogen is high,hemoglobin is low,low-density lipoprotein is high,fasting blood glucose is high,2-hour postprandial blood glucose is high,albumin is low,and D-dimer is high,it is necessary to be alert to the possibility of partial necrosis of free flaps after surgery,and make corresponding adjustments before surgery to avoid the occurrence of partial necrosis of free flaps.
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