Ibrahim Ahmed M S, Kim Peter S, Rabie Amr N, Lee Bernard T, Lin Samuel J
From the Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Ann Plast Surg. 2014 Aug;73(2):245-8. doi: 10.1097/SAP.0b013e31828d70b3.
Use of intraoperative vasopressors is of debate in microvascular surgery. Anesthesia is an important factor in maintaining the rate of success of flap transfer by affecting regional blood flow and global hemodynamics. We conducted a review of the literature comparing the use of different vasoactive agents on different flaps in various human and animal models.
A systematic review of the literature was performed. Bibliographies of key articles were also reviewed for additional resources. Analysis was done to determine the overall trend of how flap perfusion is affected by the use of intraoperative vasoactive medication.
The literature search identified 16 relevant articles. Flaps were studied in pigs in 7 studies, rats in 5, and humans in 4. The most common flap was the rectus abdominis musculocutaneous flap. Phenylephrine and norepinephrine were the most common pressor agents used. No significant statistical changes were noted in 8 of the 16 studies; initial ischemia followed by delayed improved perfusion was observed in 4 studies, "true ischemia" and hypoperfusion of the skin flaps was noted in 3. There was no consistency in their effect on flap perfusion: initial ischemia followed by delayed improved perfusion was observed in 4 studies, whereas true ischemia and hypoperfusion of the skin flaps was noted in 3.
To date, there is no reliable prospective clinical evidence that supports the absolute contraindication of pressor agents during free flap surgery. This topic will continue to be a matter for debate until more definitive data can be obtained.
术中血管升压药在微血管手术中的应用存在争议。麻醉是影响局部血流和整体血流动力学从而维持皮瓣移植成功率的重要因素。我们对文献进行了综述，比较了在各种人类和动物模型中不同皮瓣上使用不同血管活性药物的情况。
对文献进行了系统综述。还查阅了关键文章的参考文献以获取更多资源。进行分析以确定术中使用血管活性药物对皮瓣灌注影响的总体趋势。
文献检索确定了16篇相关文章。7项研究在猪身上研究皮瓣，5项在大鼠身上，4项在人类身上。最常见的皮瓣是腹直肌肌皮瓣。去氧肾上腺素和去甲肾上腺素是最常用的升压药。16项研究中有8项未观察到显著的统计学变化；4项研究观察到初始缺血后灌注延迟改善，3项研究注意到皮瓣出现“真正的缺血”和灌注不足。它们对皮瓣灌注的影响并不一致：4项研究观察到初始缺血后灌注延迟改善，而3项研究注意到皮瓣出现真正的缺血和灌注不足。
迄今为止，尚无可靠的前瞻性临床证据支持游离皮瓣手术期间绝对禁忌使用升压药。在获得更多确切数据之前，这个话题仍将是一个有争议的问题。
