| Objective:In the anticoagulant therapy after replantation of severed finger,Through the comparison of difference of low,middle,high dose Zhilonghuo xuetongyu Capsule on postoperative vascular crisis occurred,replantation finger survival rate,coagulation function,blood rheology changes,hrombosis effect and safety confirmed Zhilonghuoxuetongyu Capsule on prevention after replantation of amputated finger vascular crisis of curative effect,determine of Zhilonghuoxuetongyu Capsule has the best effect and safest on dose.Method S:The cases comes from January 2014 to January 2016 of hospital xx x hand surgery patients,we select 200 cases of replantation patients as a clinical study,the 200 cases of 243 fingers replantation surgery patients were randomly divided into four groups,the control group of 50 people59 fingers to(group A):the conventional anti infection,anti spasm and expansion therapy after finger replantation.Conventional treatment,in addition to the other three groups for the treatment group treated with control group the same routine treatment and were treated with low,medium dose and high dose Zhilonghuoxuetongyu Capsule after oral administration,specifically as follows:Zhilonghuoxuetongyu Capsule low do se group of 50 people 63 fingers(group B):Zhilonghuoxuetongyu Capsule2 pills Tid therapy+conventional basic therapy;Zhilonghuoxuetongyu Capsule medium dose group of 50 people 61 fingers(group C):Zhilonghu oxuetongyu Capsule 3 pills Tid therapy+conventional basic therapy;Zhilong huoxuetongyu Capsule high dose group of 50 people 60 fingers(group D):Zhilonghuoxuetongyu Capsule 4 pills Tid therapy+conventional basic therapy.Four groups of gender,age,basal index,finger print,digital time,and blood routine,liver and kidney function,blood lipid,fasting blood glucose data differences had no statistical significance(P>0.05),with comparability.Four groups of patients were given the same basic treatment:clindamycin phosphate anti infection,0.3g intravenously Bid;low moleculardextran expansion reduce bloodviscosity,250 ml Bid;dexamethasone anti-inflammator y,10 mg IVGTT Qd;papaverine injection anti spasm,30mgqd;localsustained infrared radiation therapy once a day,30 min each time.At the time of admission,Four groups admitted to the three conventional,liver and kidney function,electrolyte,blood coagulation function,electrocardiogram,abdominal ultrasonography and chest X-ray were admitted to the hospital routine examination;At the time of discharge,three conventional,liver and kidney function,electrolyte;keep records of patients experienced adverse reactions.All patients were operated by the same kind of anesthesia,with a group of physicians,to complete the same operation mode.Observed and compared groups of patients with vascular crisis occurred rate,replantation survival rate,the postoperative 1,2,7 days coagulation function,blood rheology changes such as comprehensive evaluation of curative effect;blood p-selection,vascular von Willebrand factor(von Willebrand factor,v WF) changes,the risk of the evaluation of thrombus formation;detection suffer from general information,securityclassification,evaluation of safety.All data are used SPSS19.0 software,chi square test,variance analysis,take?=0.05 for the test,that is P<0.05 the difference was statistically significant.Result S:1.Comparison of the general situation Patients in each group of gender,age,basal index,finger print,digital time;routine blood test:white blood cell count(WBC),addicted to neutrophil ratio(n%),platelet count(PLT);liver function:plasma albumin(ALB),globulin(GLB) and alanine aminotransferase(ALT),aspartic acid transaminase(AST);renal function:blood urea nitrogen(BUN),blood creatinine(SCR);blood lipid: triglyceride(TG),total cholesterol(TC);fasting plasma glucose(FPG),the differences had no statistical significance(P>0.05),with comparability.2.Comparison of the vascular crisis rate and survival rate of replanta tion after replantation Each group of patients after finger replantation compared the incidence of vascular crisis,18% in group A,16%in group B,2% in group C,and 2% in group D;Each group of patients after finger replantation compared the replanted fingers survival rate,83.05% in group A,84.13%in group B,96.72% in group C,and 98.33% in group D. Show that Zhilo nghuoxuetongyu capsule can reduce after replantation and the incidence rate of postoperative vascular crisis and improve the replantation of severed finger replantation survival rate and the curative effect of low dose was not significant(P>0.05),middle dose and high dose efficacy Significantly(P<0.05),and the two equivalent efficacy(P>0.05).3.Effect on blood coagulation function Detection of coagulation function:prothrombin time Pt(s),international normalized ratio(INR),activation partial thromboplastin time APTT(s),fibrin original FIB(g/L) were determined.The results showedthat groups of coagulation indexes were no statistical significance(P>0.05),with comparability.After anticoagulant therapy,PT?APTT time were prolonged,INR increased,Fbg increased significantly of each group,the curative effect of anticoagulant treatment group(P>0.05);Zhilonghuoxuetongyu capsule Low dose group compared with the control group,anticoagulant effect difference was not significant(P>0.05);middle dose group and high dose group respectively compared with control group and low dose group,the differ were significant(P<0.05);and between the middle dose group and high dose group compared anticoagulant effect difference was not significant(P>0.05).4.The changes of blood rheology The results showed that all patients with preoperative blood rheologyindex had no significant difference(P>0.05),with comparability.Postoperative anticoagulant therapy,each medication canreduce blood Viscosity(P<0.05);Zhilonghuoxuetongyu capsule could reduce the blood viscosity and low doses reduce blood viscosity effect compared with the control group had no significant difference(P>0.05),when in middle dose and high dose respectively comparedwith the control group and low dose group difference was significant(P<0.05),and high dose and middle dose effects in reducing blood viscosity(P>0.05).5.Determination of v WF and P-selection Preoperative blood serum in patients with P-selectin and v WF content had no significant difference(P>0.05),with comparability.Postoperative period and preoperative comparison,P-selectin and VWF in blood of patients in each group were significantly decreased(P<0.05);Zhilonghuoxuetongyu capsule each dose group compared to the control group,reduce blood P-selectin and VWF significantly(P<0.05),which can prevent the formation of thrombus,and there is a dosedependent,Middle dose group and high dose group compared with low dose group respectively were more significant(P<0.05),and the two equivalent efficacy(P>0.05).6.Safety Evaluation Each group received 7 days later,WBC,N%,PLT,ALB,GLB,ALT,AST,TG,TC,FPG,BUN and Scr were normal and there were no significant differences(P>0.05),check the urine and stool routine were normal.Safety classification comparison showed that the adverse reaction rate was13.8% respectively in group A,13.8% in group B,18% in group C,20.6%in group D;the excellent and good rate of the group respectively 94% in group A,94% in group B,92% in group C,84% in group D;and adverse reaction rate and excellent and good rate difference had no significant Difference(P>0.05).Which low dose and middle dose Zhilonghuoxuetongy u capsule treatment group security level excellent and good rate were in more than 90%,high dose group,the excellent and good rate was below90%,Compared with low dose group and medium dose group was lower.Conclusion:1.Zhilonghuoxuetongyu capsule can reduce the incidence of vascular crisis,improve the replantation survival rate after replantation of amputated finger,play a role in vascular protection,the effect of prevention and treatment of vascular crisis after replantation of severed finger was exact.2.The effect of Zhilonghuoxuetongyu Capsule 3 pills Tid therapy on prevention and treatment of vascular protective effects on vascular crisis after replantation of severed finger is significant,and the security is good. |
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