Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 405 - файл

A successful operation of nger reconstruction is based on not only the microsurgery technique but also the medi­cines used postoperatively (Table 5.1). Three kinds of medicines are generally used after an operation, which are antibiotics, antispasmodics, and anticoagulant drugs. Antibiotics must be used intraoperatively and postopera­tively because of complexity and the long duration of the operation. The common reasons why antispasmodic drugs and anticoagulant drugs should be used after an operation are: (1) As a body’s protective physiological response, blood coagulability is increased after injury and opera­tion; (2) Adrenaline is released after the injury and opera­tion; therefore, patients are prone to experiencing vasospasm, an increase in platelets and an increase in blood coagulation, which easily leads to thrombosis; (3) Because of the small diameter, spasticity and thrombosis can be easily induced, which is commonly 1–3 mm (a minimum of 0.2–0.5 mm), and easy susceptibility to physicochemical factors; (4) There is a higher possibility of thrombosis because of the small scouring force to anas­tomotic stoma caused by the small diameter and low blood ow. Using antispasmodic drugs and anticoagulant drugs is necessary because experiments have proved that the smaller diameter of the vessel, the more likely it is that thrombosis will occur because the 1-mm vessel has a platelet absorption density twice as high as the 2 mm vessel.

Antibiotics are mainly used in replantation to prevent and treat infection, because of the particularity of nger recon­struction, sometimes there may be fungal infection and other serious infections in donor site, then antifungal drugs and special antibiotics are needed. Therefore anti-inammatory drugs here should be called antibiotic drugs.

Anaphylaxis is most common including rashes, hives, drug eruptions, eosinophilic leukocytosis, etc. Anaphylactic shock occasionally occurs.

Fungal infections can be divided into supercial fungal infections and deep fungal infections. Supercial fungal infections are caused by tinea bacteria invasion of skin, hair, nger (toe), and other parts of the body, the incidence of which is higher but less harmful; Deep fungal infections are caused by candida and cryptococcus invasion of internal organs and deep tissues, the incidence of which is lower but more harmful.

(1) Anaphylaxis: Skin pruritus which is refractory pruritus, the disease course of individual patients may last more than 6 months which is the most prominent complication. This type of pruritus is characterized by prolonged duration, no effective palliative therapy, and patients often nd it difcult to tolerate, which may be the main reason why it is not the rst choice in clinic. There are still a few cases of anaphylac­tic shock, so the rst infusion should be closely observed for 5–10 min, once symptoms are found the drug should be stopped as soon as possible; (2) Occasional febrile reactions; (3) Excessive dosage can lead to bleeding such as epistaxis, skin and mucous membrane bleeding, gingival bleeding, wound bleeding, hematuria, etc. The daily dosage should not exceed 1500mL.

(1) Patients with congestive heart failure and hemorrhagic disease are contraindicated; (2) Patients with liver and kid­ney diseases should use with caution.

(1) Gastrointestinal symptoms: The most common adverse reactions include nausea, vomiting, abdominal discomfort, or pain; (2) Anaphylaxis which is common in middle-aged persons or rhinitis, nasal polyp patients; (3) Central nervous system: Neurological symptoms generally appear when the dosage is large, the so-called salicylic acid action including headache, dizziness, tinnitus, vision and hearing loss, when the dosage is too large, can appear neurological disorder, convulsion, even coma, etc., which can be completely recov­ered after drug withdraw 2–3 days; (4) Liver damage; (5) Kidney damage; (6) Effects on blood: Long-term use can lead to iron deciency anemia; (7) Cardiac toxicity; (8) Cross anaphylaxis.

(1) Due to the strong stimulation of papaverine, local edema appears after long-term intramuscular injection which will bring great pain to patients; (2) Liver damage; (3) Excessive dosage will cause blurred vision, double vision, lethargy, or(and) weak­ness; (4) It can inhibit the mitochondrial oxidation reaction and cause severe lactic acidosis, an increase of blood ketone, mild hyperglycemia and hypoglycemia after large intake; (5) It can cause breath to deepen and thrombocytopenia.

(1) The main side effects include dry mouth, upper abdomi­nal discomfort, fatigue, sleepiness, constipation, and palpita­tion. Lactation, breast enlargement, obesity, and amenorrhea, etc., occasionally occur; (2) Postural hypotension may be induced by injection or oral administration of large doses; (3) Liver damage.

(1) Patients should lie still for 1–2h after drug administra­tion, when the blood pressure is too low, noradrenaline or ephedrine can be used but not epinephrine; (2) Liver func­tion should be checked regularly when it is long-term used.

Analgesia pump is divided into epidural pump and venous pump because of different drugs in it. Epidural pump is often used with local anesthetics and morphine while venous pump is used with fentanyl and the use of the two kinds of pump should be strictly distinguished, otherwise, it will be dangerous.

(1) No one except the anesthesiologist is allowed to change the way the pump is administered; (2) Maintain the smooth­ness of T-joint; (3) The epidural pump should be removed by anesthesiologists.