Department of Otolaryngology - Head and Neck Surgery, Dana Farber Cancer Institute, Boston, Massachusetts.
Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Head Neck. 2018 Nov;40(11):2334-2339. doi: 10.1002/hed.25190. Epub 2018 Sep 19.
In free flap head and neck reconstructions, hemodynamic management is complicated by the deleterious effects of excessive crystalloid administration. Patients may undergo periods of hypotension or excess fluid administration. The purpose of this study was to present our examination of the hypotheses that intraoperative hypotension and blood pressure lability are associated with increased fluid administration and flap failure.
We reviewed the records of 445 patients undergoing head and neck surgery involving free tissue transfer. We used multivariate logistic regression to examine the relationship between hemodynamic variables and flap loss (primary outcome) and other complications.
On multivariate analysis, intraoperative hypotension and large-volume fluid administration were associated with flap loss. Neither blood pressure lability nor vasopressor administration was significantly associated to our primary outcome.
Intraoperative hypotension is associated to flap failure in head and neck free tissue transfer surgeries, as is large-volume fluid administration.
在游离皮瓣头颈部重建中，由于晶体液过度输注的有害影响，血液动力学管理变得复杂。患者可能会经历低血压或过度液体输注期。本研究的目的是提出我们的假设检验，即术中低血压和血压波动与增加的液体输注和皮瓣失败有关。
我们回顾了 445 例接受游离组织转移的头颈部手术患者的记录。我们使用多变量逻辑回归来检查血流动力学变量与皮瓣丧失（主要结果）和其他并发症之间的关系。
多变量分析显示，术中低血压和大量液体输注与皮瓣丧失相关。血压波动和血管加压药的使用均与我们的主要结果无显著相关性。
在游离皮瓣头颈部转移手术中，术中低血压与皮瓣失败有关，大量液体输注也是如此。
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