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术后非镇静是否能改善头颈癌重建术后患者的预后?一项遵循STROBE标准的研究。

Does postoperative non-sedation improve outcomes for patients after head and neck cancer reconstruction?: A STROBE compliant study.

作者信息

Wu Cho-Han, Yang Wen-Chi, Wu Shih-Chi, Chen Jian-Xun, Lin Mei-Chen, Chang Chang-Cheng, Shih Pin-Keng

机构信息

Department of Surgery, China Medical University Hospital.

College of Medicine, China Medical University, Taichung.

出版信息

Medicine (Baltimore). 2020 Nov 13;99(46):e23147. doi: 10.1097/MD.0000000000023147.

DOI:10.1097/MD.0000000000023147
PMID:33181685
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7668500/
Abstract

Whether a strategy of postoperative non-sedation produces better outcomes compared with sedation in patients after head and neck reconstruction remains controversial. Therefore, we retrospectively investigated outcomes in 150 of these patients in our institution.Patients with head and neck cancer that received free anterolateral thigh flap were studied retrospectively, and were categorized in terms of their postoperative care into "sedation" and "non-sedation" groups. The related parameters of each patient were collected for analysis.Overall, 150 patients were included (sedation protocol (N = 56) and non-sedation strategy (N = 94)). No significant differences were observed between groups in patient demographics or postoperative outcomes. Significantly shorter durations of mean and median intensive care unit (ICU) length of stay, mechanical ventilation, hospitalization, and operative time were observed in the non-sedation group than in the sedation group. Among all patients, the sedation and flap reopen were the common variables related to prolonged ICU stay, mechanical ventilator duration, and hospitalization.The current study suggested the strategy of postoperative non-sedation is associated with a significant decrease in the duration of mechanical ventilation, ICU length of stay, hospitalization. Regardless of hospital stay, there were no differences in postoperative outcome between 2 groups.

摘要

与镇静相比,头颈部重建术后非镇静策略是否能产生更好的效果仍存在争议。因此,我们对本院150例此类患者的治疗结果进行了回顾性研究。对接受游离股前外侧皮瓣的头颈部癌症患者进行回顾性研究,并根据术后护理情况将其分为“镇静”组和“非镇静”组。收集每位患者的相关参数进行分析。

总体而言,共纳入150例患者(镇静方案组(N = 56)和非镇静策略组(N = 94))。两组患者的人口统计学特征或术后结果无显著差异。与镇静组相比,非镇静组的平均和中位重症监护病房(ICU)住院时间、机械通气时间、住院时间和手术时间明显更短。在所有患者中,镇静和皮瓣重新开放是与ICU住院时间延长、机械通气时间和住院时间相关的常见变量。

本研究表明,术后非镇静策略与机械通气时间、ICU住院时间和住院时间的显著缩短有关。无论住院时间长短,两组术后结果均无差异。

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本文引用的文献

1
Use of a non-ICU specialty ward for immediate post-operative management of head and neck free flaps; a randomized controlled trial.使用非 ICU 专科病房进行头颈部游离皮瓣术后即刻管理;一项随机对照试验。
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Ann Plast Surg. 2020 Jan;84(1):68-72. doi: 10.1097/SAP.0000000000001953.
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Intensive Care Unit Versus Ward Management After Anterolateral Thigh Flap Reconstruction After Oral Cancer Ablation.口腔癌切除术后股前外侧皮瓣重建后的重症监护病房与病房管理
Ann Plast Surg. 2018 Feb;80(2S Suppl 1):S11-S14. doi: 10.1097/SAP.0000000000001301.
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Laryngoscope. 2013 Dec;123(12):2996-3000. doi: 10.1002/lary.24241. Epub 2013 Jun 28.
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Postoperative alcohol withdrawal syndrome and neuropsychological disorder in patients after head and neck cancer ablation followed by microsurgical free tissue transfer.头颈部癌症消融术后行显微游离组织移植后患者的术后酒精戒断综合征和神经认知障碍。
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Immediate postoperative extubation in patients undergoing free tissue transfer.患者接受游离组织移植后即刻拔管。
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9
Microsurgical tissue transfers for head and neck reconstruction in patients with alcohol-induced mental disorder.酒精所致精神障碍患者头颈部重建的显微外科组织移植术
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