Nelson Jonas A, Fischer John P, Grover Ritwik, Nelson Priscilla, Au Alex, Serletti Joseph M, Wu Liza C
a Division of Plastic Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA.
b Department of Plastic Surgery , Cleveland Clinic , Cleveland , OH , USA.
J Plast Surg Hand Surg. 2017 Oct;51(5):336-341. doi: 10.1080/2000656X.2016.1269777. Epub 2017 Jan 13.
The purpose of this study was to critically examine intraoperative vasopressor usage as it relates to free flap perfusion and its effect on perioperative complications in autologous breast reconstruction.
A retrospective cohort study was performed involving all free autologous breast reconstructions at a single institution over a 5 year period. Data collection focused on perioperative care, specifically fluid administration, urine output (UOP), use of vasopressors, and case duration. Outcomes included major intraoperative and postoperative complications. Patients who received intraoperative vasopressors were compared to all patients who did not. The use, type, and timing of the vasopressor agent were assessed with standard statistical analyses and regression modelling.
Six hundred and eighty-two patients reconstructed with 1039 flaps were included. Of these, 475 (69.6%) patients received vasopressors. The vasopressor cohort was older (p = 0.001), with higher rates of hypertension (p = 0.02). They had a greater number of hypotensive episodes (2.3 vs 0.8, p < 0.0001) and received a greater volume of fluid (4653.0 vs 4291.7 ml, p = 0.004). Examining complications, no increase in intraoperative thrombotic events (arterial or venous) or flap loss was noted with vasopressor administration. A higher rate of minor complications was, however, noted (53.1% vs 43.0%, p = 0.016).
This study demonstrates that the use of intraoperative vasopressor agents in the anaesthetic care of free flap breast reconstruction patients is common, but likely does not impact thrombotic events or flap loss. Minor complications may, however, be more common in these patients.
本研究旨在严格审查术中血管升压药的使用情况，及其与游离皮瓣灌注的关系以及对自体乳房重建围手术期并发症的影响。
进行了一项回顾性队列研究，纳入了某单一机构在5年期间内所有的自体游离乳房重建手术。数据收集集中在围手术期护理，特别是液体管理、尿量（UOP）、血管升压药的使用以及手术时长。结果包括主要的术中和术后并发症。将接受术中血管升压药治疗的患者与所有未接受治疗的患者进行比较。使用标准统计分析和回归模型评估血管升压药的使用、类型和给药时间。
纳入了682例接受1039例皮瓣重建的患者。其中，475例（69.6%）患者接受了血管升压药治疗。接受血管升压药治疗的患者队列年龄更大（p = 0.001），高血压发生率更高（p = 0.02）。他们发生低血压事件的次数更多（2.3次对0.8次，p < 0.0001），且接受的液体量更多（4653.0毫升对4291.7毫升，p = 0.004）。在检查并发症时，未发现使用血管升压药会增加术中血栓形成事件（动脉或静脉）或皮瓣丢失的情况。然而，发现轻微并发症的发生率更高（53.1%对43.0%，p = 0.016）。
本研究表明，在游离皮瓣乳房重建患者的麻醉护理中使用术中血管升压药很常见，但可能不会影响血栓形成事件或皮瓣丢失。然而，这些患者中轻微并发症可能更常见。
