Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto Western Hand Program, Toronto, Ontario, Canada.
Division of Plastic and Reconstructive Surgery, William Osler Health System - Brampton Civic Hospital, Brampton, Ontario, Canada.
Microsurgery. 2020 Jan;40(1):5-11. doi: 10.1002/micr.30461. Epub 2019 Apr 16.
Despite the common use of intraoperative vasopressors in hand microsurgery, the association between intraoperative vasopressor use and digital replant failure has not yet been examined. Our study aims to examine the association between intraoperative vasopressor use (phenylephrine and/or ephedrine) and postoperative digital failure of replanted or revascularized digits.
All patients from a single tertiary hand center who underwent unilateral digital replantation or revascularization procedures between 2005 and 2016 were included in this retrospective cohort study. The relationship between intraoperative vasopressors used to maintain hemodynamic stability and digit failure was then evaluated using logistic regression. Specifically, phenylephrine (total dose 10-3,600 mcg) and ephedrine (5-110 mg) use were evaluated.
During the study period, 281 patients underwent digital replantation or revascularization. Of those, 86 (31%) were given an intraoperative vasopressor. Digit failure was more likely in patients with crush or avulsion injuries compared to clean-cut mechanism (odds ratio [OR] 2.02, p = .02), and in patients with replantation (OR 7.85, p < .0001) as compared to revascularization procedures. Using multivariate logistic regression adjusting for age, sex, smoking status, comorbidities, number of digits injured, injury type, and procedure type, the odds of digital failure with vasopressor use were not increased (p = .84). When evaluating vasopressors used after tourniquet deflation, failure increased with ephedrine use (OR = 2.42, p = .0496) and phenylephrine use (OR = 2.21, p = .31).
The use of vasopressors was not associated with failure if administration of vasopressors was before tourniquet deflation. The administration of vasopressors after tourniquet deflation should be cautioned.
尽管在手部显微手术中经常使用术中血管加压药，但术中使用血管加压药与手指再植失败之间的关系尚未得到检验。我们的研究旨在检查术中使用血管加压药（苯肾上腺素和/或麻黄碱）与再植或再血管化手指的术后数字失败之间的关系。
本回顾性队列研究纳入了 2005 年至 2016 年间在一家三级手部中心接受单侧手指再植或再血管化手术的所有患者。然后使用逻辑回归评估用于维持血流动力学稳定的术中血管加压药与手指失败之间的关系。具体而言，评估了苯肾上腺素（总剂量 10-3600μg）和麻黄碱（5-110mg）的使用。
在研究期间，有 281 例患者接受了手指再植或再血管化手术。其中 86 例（31%）给予了术中血管加压药。与切割伤机制相比，挤压伤或撕脱伤患者的手指失败更有可能（优势比[OR] 2.02，p=0.02），与再血管化手术相比，再植患者的手指失败更有可能（OR 7.85，p<0.0001）。使用多元逻辑回归调整年龄、性别、吸烟状况、合并症、受伤手指数量、损伤类型和手术类型，使用血管加压药并不会增加手指失败的几率（p=0.84）。当评估止血带放气后使用的血管加压药时，与使用麻黄碱（OR=2.42，p=0.0496）和苯肾上腺素（OR=2.21，p=0.31）相关的失败增加。
如果在止血带放气之前给予血管加压药，则使用血管加压药与失败无关。应谨慎使用止血带放气后的血管加压药。
