Kroll S S, Sharma S, Koutz C, Langstein H N, Robb G L, Chang D W, Reece G P
Department of Plastic Surgery at The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Plast Reconstr Surg. 2001 Feb;107(2):338-41. doi: 10.1097/00006534-200102000-00006.
In a review of the charts of 158 patients who had undergone breast reconstruction with free transverse rectus abdominis musculocutaneous (TRAM) or deep inferior epigastric perforator (DIEP) flaps and who were treated for postoperative pain with morphine administered by a patient-controlled analgesia pump, the total dose of morphine administered during hospitalization for the flap transfer was measured. Patients whose treatment was supplemented by other intravenous narcotics were excluded from the study. The mean amount of morphine per kilogram required by patients who had reconstruction with DIEP flaps (0.74 mg/kg, n = 26) was found to be significantly less than the amount required by patients who had reconstruction with TRAM flaps (1.65 mg/kg; n = 132; p < 0.001). DIEP flap patients also remained in the hospital less time (mean, 4.73 days) than did free TRAM flap patients (mean, 5.21 days; p = 0.026), but the difference was less than one full hospital day. It was concluded that the use of the DIEP flap does reduce the patient requirement for postoperative pain medication and therefore presumably reduces postoperative pain. It may also slightly shorten hospital stay.
在一项对158例接受游离腹直肌肌皮瓣（TRAM）或腹壁下深动脉穿支皮瓣（DIEP）乳房重建的患者病历的回顾中，这些患者通过患者自控镇痛泵使用吗啡治疗术后疼痛，测量了皮瓣转移住院期间给予的吗啡总剂量。接受其他静脉麻醉药补充治疗的患者被排除在研究之外。发现接受DIEP皮瓣重建的患者每公斤所需的平均吗啡量（0.74mg/kg，n = 26）明显少于接受TRAM皮瓣重建的患者（1.65mg/kg；n = 132；p < 0.001）。DIEP皮瓣患者的住院时间（平均4.73天）也比游离TRAM皮瓣患者（平均5.21天；p = 0.026）短，但差异不到一个完整的住院日。得出的结论是，使用DIEP皮瓣确实减少了患者术后疼痛药物的需求，因此可能减轻了术后疼痛。它也可能略微缩短住院时间。
