Dekker Paige K, Noe Niki, Bekeny Jenna C, Lavin Christopher, Zolper Elizabeth G, Song David H, Fan Kenneth L
Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, D.C.
Georgetown University School of Medicine, Washington, D.C.
Plast Reconstr Surg Glob Open. 2021 Jan 21;9(1):e3284. doi: 10.1097/GOX.0000000000003284. eCollection 2021 Jan.
Despite the lack of guidelines regarding the use of intra-arterial lines in postmastectomy breast reconstruction (PMBR), they continue to be used in this setting. In this study of patients undergoing PMBR, we aimed to (1) identify factors associated with intra-arterial line placement, (2) analyze the correlation between intra-arterial monitoring and noninvasive blood pressure (NIBP) monitoring, and (3) investigate whether hemodynamic management differs significantly between patients undergoing intra-arterial blood pressure monitoring versus NIBP.
All patients undergoing flap-based PMBR between 2017 and 2019 were retrospectively reviewed. Patients were pair-matched based on flap donor site, BMI, and age to identify factors associated with intra-arterial line placement. Methods described by Bland and Altman were utilized to determine agreement between intra-arterial line measurements and NIBP.
Thirty-two patients were included with 16 patients in the intra-arterial line group and 16 in the NIBP group. None of the factors studied were significantly related to the likelihood of intra-arterial line placement. Agreement analysis demonstrated that mean arterial pressures calculated from intra-arterial line readings were as much as 23 points lower or 12 points higher than those from NIBP. Bias calculations with this extent of difference suggest poor correlation between intra-arterial line readings and NIBP. There was no difference between groups in rate of administration of blood-pressure altering medications (hypertensive: n = 3, 18.8%, = 1.000; hypotensive: n = 7, 3.8%, = 1.000).
Our findings highlight the need for more definitive guidance regarding the use of intra-arterial monitoring in patients undergoing PMBR.
尽管在乳房切除术后乳房重建（PMBR）中使用动脉内导管缺乏相关指南，但在这种情况下仍继续使用。在这项针对接受PMBR的患者的研究中，我们旨在：（1）确定与动脉内导管放置相关的因素；（2）分析动脉内监测与无创血压（NIBP）监测之间的相关性；（3）研究接受动脉内血压监测的患者与接受NIBP监测的患者之间的血流动力学管理是否存在显著差异。
回顾性分析2017年至2019年间所有接受皮瓣移植PMBR的患者。根据皮瓣供区、BMI和年龄对患者进行配对匹配，以确定与动脉内导管放置相关的因素。采用Bland和Altman描述的方法来确定动脉内导管测量值与NIBP之间的一致性。
纳入32例患者，动脉内导管组16例，NIBP组16例。所研究的因素均与动脉内导管放置的可能性无显著相关性。一致性分析表明，根据动脉内导管读数计算的平均动脉压比NIBP测量值低23个点或高12个点。如此大差异程度的偏差计算表明动脉内导管读数与NIBP之间相关性较差。两组间使用改变血压药物的比例无差异（高血压：n = 3，18.8%，P = 1.000；低血压：n = 7，3.8%，P = 1.000）。
我们的研究结果强调了对于接受PMBR的患者使用动脉内监测需要更明确指导的必要性。
