Objective  To explore the application value of popaverine combined with stage rehabilitation for patients after free flap grafting for hand trauma.

Methods  Data of postoperative patients who underwent hand trauma from January 2021 to January 2022 in The 903rd Hospital of the Joint Logistics Support Force of the People's Liberation Army of Chinawere retrospectively collected, and they were divided into the combined rehabilitation group (poppadine combined with stage rehabilitation care) and the stage rehabilitation group (only stage rehabilitation care was applied) according to the treatment methods. Visual analog scale (VAS) scores, rehabilitation exercise adherence scores, postoperative rates of excellent cutaneous sensory function of the hand, total active mobility (TAM) of the fingers, Jamar grip strength, upper extremity functional assessment (DASH) scale scores, and the incidence of vascular crises were compared between the two groups.

Results  A total of 120 cases were included in the study, with 57 cases in the combined rehabilitation group and 63 cases in the stage rehabilitation group. There was no statistically significant difference in VAS scores, Jamar grip strength and DASH scores between the two groups before surgery (P>0.05); at 14 days and 3 months of intervention, VAS scores of the two groups decreased compared with the pre-intervention period (P<0.05), and VAS scores of the patients in the combined rehabilitation group were significantly lower than those in the stage rehabilitation group (P<0.05). After 3 months of intervention, the rehabilitation exercise adherence score, the rate of excellent hand skin sensory function, and finger TAM of the patients in the combined rehabilitation group were higher than those in the stage rehabilitation group (P<0.05); Jamar grip strength were elevated in both groups compared with the pre-intervention period, but the combined rehabilitation group were higher than those in the stage rehabilitation group (P<0.05); DSAH scores were lower in both groups compared to pre-intervention, and were lower in the combined rehabilitation group than in the stage rehabilitation group; and during the 3 months of intervention, the incidence of vascular crisis was significantly lower in patients in the combined rehabilitation group than in the stage rehabilitation group (P<0.05).

Conclusion  Opium poppy alkaloids combined with stage rehabilitation can effectively reduce patients' postoperative pain, enhance patients' adherence to rehabilitation exercises, effectively improve postoperative hand function and upper limb motor function, and reduce the incidence of vascular crisis.

1.Welling H, Vesterholm KS, Toyserkani N, et al. Local flaps of the hand[J]. Ugeskr Laeger, 2024, 186(5): V05230324. DOI: 10.61409/V05230324.

2.Langdell HC, Shammas RL, Atia A, et al. Vein grafts in free flap reconstruction: review of indications and institutional pearls[J]. Plast Reconstr Surg, 2022, 149(3): 742-749. DOI: 10.1097/PRS.0000000000008856.

3.范涌熙, Kenmegne GR, 余游, 等. 腓肠内侧动脉穿支皮瓣在同侧下肢中小面积皮肤软组织创面修复中的临床应用[J]. 华西医学, 2023, 38(10): 1461-1467. [Fan  YX, Kenmegne GR, Yu Y, et al. Clinical application of the peroneal artery perforator flap in the repair of small-area skin and soft tissue wounds on the ipsilateral lower limb[J]. West China Medical Journal, 2023, 38(10): 1461-1467.] DOI: 10.7507/1002-0179.202309022.

4.魏晓涛, 张玉昌, 何志军, 等. 活性氧对缺血再灌注损伤皮瓣的影响及中药干预研究进展[J]. 数理医药学杂志, 2024, 37(4): 287-292. [Wei XT, Zhang YC, He  ZJ, et al. Effects of reactive oxygen species on ischemia-reperfusion injury of skin flaps and advances in traditional Chinese medicine interventions[J]. Journal of Mathematical Medicine, 2024, 37(4): 287-292.] DOI: 10.12173/j.issn.1004-4337.202312026.

5.Dhellemmes O, Mouton J, Auquit-Auckbur I. Hand emergencies: patient information is often neglected[J]. J Hand Surg Eur Vol, 2023, 48(2): 153-154. DOI: 10.1177/17531934221132638.

6.Seth R, Badran KW, Cedars E, et al. Vasodilation by verapamil-nitroglycerin solution in microvascular surgery[J]. Otolaryngol Head Neck Surg, 2021, 164(1): 104-109. DOI: 10.1177/0194599820937991.

7.Mücke T, Hapfelmeier A, Schmidt LH, et al. A comparative analysis using flowmeter, laser-Doppler spectrophotometry, and indocyanine green-videoangiography for detection of vascular stenosis in free flaps[J]. Sci Rep, 2020, 10(1): 939. DOI: 10.1038/s41598-020-57777-2.

8.Rinkinen J, Halvorson EG. Topical vasodilators in microsurgery: what is the evidence?[J]. J Reconstr Microsurg, 2017, 33(1): 1-7. DOI: 10.1055/s-0036-1592191.

9.Gomes DA, Joubert AM, Visagie MH. The biological relevance of papaverine in cancer[J]. Cells, 2022, 11(21): 3385. DOI: 10.3390/cells11213385.

10.于淼淼, 魏瑄. 护理干预配合罂粟碱治疗对断指再植术后疼痛和血管痉挛的预防效果[J]. 中国药物滥用防治杂志, 2023, 29(2): 221-223. [Yu MM, Wei X. Prevention effects of nursing intervention combined with papaverine treatment on pain and vascular spasm after finger replantation surgery[J]. Chinese Journal of Drug Abuse Prevention and Treatment, 2023, 29(2): 221-223.] DOI: 10.15900/j.cnki.zylf1995.2023.02.010.

11.李莹, 杨巧巧, 党晨珀, 等. 跟腱断裂缝合术后病人实施分阶段康复护理效果的Meta分析[J]. 循证护理, 2024, 10(6): 951-957. [Li Y, Yang QQ, Dang CP, et al. Meta-analysis of phased rehabilitation nursing effects in patients undergoing achilles tendon repair[J]. Evidence-Based Nursing, 2024, 10(6): 951-957.] DOI: 10.12102/j.issn.2095-8668.2024.06.001.

12.季荔, 谢连珠, 叶秀, 等. 观察分阶段康复干预对踝骨骨折护理质量的影响[J]. 足踝外科电子杂志, 2023, 10(2): 44-47, 52. [Ji L, Xie LZ, Ye X, et al. Impact of phased rehabilitation intervention on nursing quality in ankle fracture: an observational study[J]. Electronic Journal of Foot and Ankle Surgery, 2023, 10(2): 44-47, 52.] DOI: 10.3969/j.issn.2095-7793.2023.02.011.

13.张乐韵, 徐娟. 三阶段康复锻炼联合健康宣教对全膝关节置换术患者术后康复的影响[J]. 中外医学研究, 2023, 21(3): 89-93. [Zhang LY, Xu J. Impact of three-stage rehabilitation exercise combined with health education on postoperative recovery of total knee arthroplasty patients[J]. Chinese and Foreign Medical Research, 2023, 21(3): 89-93.] DOI: 10.14033/j.cnki.cfmr.2023.03.022.

14.陈禹孜, 李莉, 葛燕露. 艾司氯胺酮复合羟考酮在剖宫产术后镇痛中的相互作用和配伍方案优化[J]. 中国药师, 2024, 27(4): 612-621. [Chen YZ, Li L, Ge YL. Interaction and compatibility optimization of ketamine combined with hydrocodone in post-cesarean section analgesia[J]. Chinese Pharmacist, 2024, 27(4): 612-621.] DOI: 10.12173/j.issn.1008-049X.202310110.

15.张曼. 乳腺癌术后患肢康复护理对患者淋巴结消肿率和上肢活动度的影响[J]. 航空航天医学杂志, 2024, 35(3): 382-384. [Zhang M. Effect of postoperative limb rehabilitation nursing on lymphedema reduction rate and upper limb mobility in patients with breast cancer[J]. Journal of Aerospace Medicine, 2024, 35(3): 382-384.] DOI: 10.3969/j.issn.2095-1434.2024.03.043.

16.夏慧, 沈蕾明. 断指再植术后再植指总主动活动度恢复情况的影响因素[J]. 吉林医学, 2022, 43(9): 2385-2388. [Xia H, Shen LM. Factors influencing the recovery of total active motion of replanted fingers after finger replantation surgery[J]. Journal of Jilin Medical College, 2022, 43(9): 2385-2388.] DOI: 10.3969/j.issn.1004-0412.2022.09.022.

17.王文洁. 序贯康复护理在手外伤游离皮瓣移植术后患者中的应用效果[J]. 中国民康医学, 2023, 35(13): 190-192. [Wang WJ. Application effectiveness of sequential rehabilitation nursing in patients undergoing free flap transplantation for hand trauma[J]. Chinese Journal of Population Medicine, 2023, 35(13): 190-192.] DOI: 10.3969/j.issn.1672-0369.2023.13.057.

18.李丽, 郭景涛. 加速康复外科理念下多学科协作干预模式在乳腺癌术后淋巴水肿康复干预中的效果[J]. 黑龙江医学, 2023, 47(24): 3019-3021. [Li L, Guo JT. The effect of multidisciplinary collaborative intervention model under the concept of enhanced recovery after surgery in rehabilitation intervention for postoperative lymphedema in breast cancer[J]. Heilongjiang Medicine, 2023, 47(24): 3019-3021.] DOI: 10.3969/j.issn.1004-5775.2023.24.022.

19.黄芳芳, 王平, 邹华仁. 肝素钠联合罂粟碱对断指再植术后凝血功能及血管危象发生的影响[J]. 实用中西医结合临床, 2023, 23(12): 105-108. [Huang FF, Wang P, Zou HR. Effects of heparin sodium combined with papaverine on coagulation function and vascular crisis after finger replantation surgery[J]. Practical Clinical Medicine of Integrated Traditional Chinese and Western Medicine, 2023, 23(12): 105-108.] DOI: 10.13638/j.issn.1671-4040.2023.12.030.

20.陈端. 阶段性康复干预方案对行膝关节置换术患者疼痛及功能恢复的影响[J]. 基层医学论坛, 2024, 28(12): 44-46. [Chen D. Effects of phased rehabilitation intervention on pain and functional recovery in patients undergoing knee arthroplasty[J]. Primary Health Care Forum, 2024, 28(12): 44-46.] DOI: 10.19435/j.1672-1721.2024.12.014.

21.宋海莎, 梁婷, 许宁杰. 基于依从性曲线变化规律阶段性护理对绝经综合征患者康复程度及心理状态的影响[J]. 医学理论与实践, 2023, 36(10): 1783-1785. [Song HS, Liang T, Xu NJ. Effects of staged nursing based on compliance curve changes on rehabilitation and psychological status of patients with menopausal syndrome[J]. Medical Theory and Practice, 2023, 36(10): 1783-1785.] DOI: 10.19381/j.issn.1001-7585.2023.10.063.

22.张玉蓉, 胡耀元. 基于计划理论的阶段性护理对急性脑梗死患者康复依从性和功能恢复的影响[J]. 现代养生, 2023, 23(18): 1404-1406. [Zhang YR, Hu YY. Effects of staged nursing based on the theory of planned behavior on rehabilitation compliance and functional recovery in patients with acute cerebral infarction[J]. Modern Health Preservation, 2023, 23(18): 1404-1406.] DOI: 10.3969/j.issn.1671-0223(s).2023.18.013.

23.Ashrafi S, Alam S, Sultana A, et al. Papaverine: a miraculous alkaloid from opium and its multimedicinal application[J]. Molecules, 2023, 28(7): 3149. DOI: 10.3390/molecules28073149.

24.Pu LLQ, Song P. Reoperative microsurgical free flap surgery: lessons learned[J]. Ann Plast Surg, 2023, 90(5S Suppl 2): S187-S194. DOI: 10.1097/SAP.0000000000003370.

25.Wang N, Xiao H, Lu H, et al. Effect of PI3K/AKT/mTOR signaling pathway-based clustered nursing care combined with papaverine injection on vascular inflammation and vascular crisis after replantation of severed fingers[J]. Mol Cell Biochem, 2024, 479(6): 1525-1534. DOI: 10.1007/s11010-023-04796-y.

26.Abass SA, Elgazar AA, El-Kholy SS, et al. Unraveling the nephroprotective potential of papaverine against cisplatin toxicity through mitigating oxidative stress and inflammation: insights from in silico, in vitro, and in vivo investigations[J]. Molecules, 2024, 29(9): 1927. DOI: 10.3390/molecules29091927.