Chen Chen, Nguyen Minh-Doan, Bar-Meir Eran, Hess Philip A, Lin Samuel, Tobias Adam M, Upton Joseph, Lee Bernard T
Department of Surgery, Boston, MA, USA.
Ann Plast Surg. 2010 Jul;65(1):28-31. doi: 10.1097/SAP.0b013e3181bda312.
The use of vasopressors during microsurgery is still debated. General anesthesia often induces hypotension, but microsurgeons are reluctant to use intraoperative vasopressors with the potential risks of vasoconstriction. A retrospective review was performed on 187 consecutive patients undergoing 258 deep inferior epigastric perforator flaps, free transverse rectus abdominis myocutaneous flap, and muscle-sparing free transverse rectus abdominis myocutaneous flap operations. A total of 102 patients (140 flaps) received intraoperative ephedrine and/or phenylephrine and 85 patients (118 flaps) did not. The administration of vasopressors did not affect the rates of reoperation, complete flap loss, partial flap loss, or fat necrosis. Patients receiving vasopressors had no differences in operative time, number of perforators, or number of rows of perforators harvested. There was no statistically significant association between dosage, timing, and complications. Although we do not recommend routine vasopressor use during microsurgery, administration does not seem to increase complications in microsurgical breast reconstruction.
在显微外科手术中使用血管升压药仍存在争议。全身麻醉常导致低血压，但显微外科医生不愿使用术中血管升压药，因为其存在血管收缩的潜在风险。对连续187例接受258例腹壁下深动脉穿支皮瓣、游离腹直肌肌皮瓣和保留肌肉的游离腹直肌肌皮瓣手术的患者进行了回顾性研究。共有102例患者（140例皮瓣）术中接受了麻黄碱和/或去氧肾上腺素，85例患者（118例皮瓣）未接受。血管升压药的使用并未影响再次手术率、皮瓣完全坏死率、部分坏死率或脂肪坏死率。接受血管升压药的患者在手术时间、穿支数量或采集的穿支行数方面没有差异。剂量、给药时机与并发症之间无统计学显著关联。虽然我们不建议在显微外科手术中常规使用血管升压药，但给药似乎不会增加显微外科乳房重建的并发症。
