Hill J Bradford, Patel Ashit, Del Corral Gabriel A, Sexton Kevin Wayne, Ehrenfeld Jesse M, Guillamondegui Oscar Dean, Shack R Bruce
Vanderbilt University Medical Center, Nashville, TN 37232-2345, USA.
Ann Plast Surg. 2012 Oct;69(4):364-7. doi: 10.1097/SAP.0b013e31823ed606.
Patients undergoing microvascular reconstruction are often anemic from a combination of iatrogenic hemodilution and acute blood losses. No major clinical study describes the impact of preoperative anemia on free flap morbidity. The plastic surgery service at a high-volume academic center performed 156 free flaps among 147 patients from December 2005 to December 2010. One hundred thirty-two had a preoperative hemoglobin (Hb) or hematocrit (Hct), with mean values of 11.8±2.4 g/dL and 35.2%±7.0%, respectively. The overall failure rate was 9% (12/132), primarily from vascular thrombosis (6/12). Through logistic regression analysis, Hb and Hct were significant predictors of flap failure (P<0.005) and vascular thrombosis (P<0.05). Fisher exact test revealed a significant increase in failure risk at Hct level less than 30% (Hb<10 g/dL) (relative risk, 4.76, P=0.006), and probit analysis demonstrated an exposure-response relationship to decreased Hct level (P<0.005). These findings support that preoperative anemia could significantly impact free flap morbidity.
接受微血管重建手术的患者常因医源性血液稀释和急性失血而出现贫血。尚无大型临床研究描述术前贫血对游离皮瓣并发症的影响。2005年12月至2010年12月期间，一家大型学术中心的整形外科团队为147例患者进行了156例游离皮瓣手术。其中132例患者有术前血红蛋白（Hb）或血细胞比容（Hct）数据，平均值分别为11.8±2.4 g/dL和35.2%±7.0%。总体失败率为9%（12/132），主要原因是血管血栓形成（6/12）。通过逻辑回归分析，Hb和Hct是皮瓣失败（P<0.005）和血管血栓形成（P<0.05）的显著预测因素。Fisher精确检验显示，Hct水平低于30%（Hb<10 g/dL）时失败风险显著增加（相对风险，4.76，P=0.006），概率分析表明失败风险与Hct水平降低呈暴露-反应关系（P<0.005）。这些发现支持术前贫血会显著影响游离皮瓣并发症。
