From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital.
Georgetown University School of Medicine; Washington, DC.
Ann Plast Surg. 2022 May 1;88(3 Suppl 3):S174-S178. doi: 10.1097/SAP.0000000000003174.
Despite the lack of clear indications for the use of intra-arterial lines (IALs) for intraoperative hemodynamic monitoring, they are often used in a variety of settings. In this retrospective review of patients undergoing free tissue transfer (FTT) for lower extremity (LE) reconstruction, we sought to (1) identify patient factors associated with IAL placement, (2) compare hemodynamic measurements obtained via IAL versus noninvasive blood pressure (NIBP) monitoring, and (3) investigate whether method of hemodynamic monitoring affected intraoperative administration of blood pressure-altering medications.
Patients undergoing LE FTT from January 2017 through June 2020 were retrospectively reviewed. Patients were pair matched based on flap donor site, sex, and body mass index to identify patient factors associated with IAL placement. Methods previously described by Bland and Altman (Lancet. 1986;327:307-310) were used to investigate agreement between IAL and NIBP measurements.
Sixty-eight patients were included with 34 patients in the IAL group and 34 in the NIBP group. Older patients (P = 0.03) and those with a higher Charlson Comorbidity Index (P = 0.05) were significantly more likely to have an IAL placed. Agreement analysis demonstrated that mean arterial pressures calculated from IAL readings were as much as 31 points lower or 28 points higher than those from NIBP. Bias calculations with this extent of difference suggest poor correlation between IAL readings and NIBP (R2 = 0.3027). There was no significant difference between groups in rate of administration of blood-pressure altering medications.
Surgeons should consider the risks and benefits of IAL placement on a case-by-case basis, particularly for patients who are young and healthy. Our findings highlight the need for clearer guidance regarding the use of IAL in patients undergoing LE FTT.
尽管动脉内导管（IA）在术中血流动力学监测中缺乏明确的适应证，但它们仍在多种情况下被广泛应用。在这项回顾性研究中，我们对接受下肢（LE）游离组织转移（FTT）重建的患者进行了研究，旨在：（1）确定与 IA 置管相关的患者因素；（2）比较通过 IA 和非侵入性血压（NIBP）监测获得的血流动力学测量值；（3）研究血流动力学监测方法是否影响术中血压调节药物的使用。
回顾性分析了 2017 年 1 月至 2020 年 6 月期间接受 LE FTT 的患者。通过 flap 供区、性别和体重指数对患者进行配对匹配，以确定与 IA 置管相关的患者因素。Bland 和 Altman（柳叶刀。1986；327:307-310）先前描述的方法用于研究 IA 和 NIBP 测量值之间的一致性。
共纳入 68 例患者，IA 组 34 例，NIBP 组 34 例。年龄较大的患者（P = 0.03）和 Charlson 合并症指数较高的患者（P = 0.05）更有可能放置 IA。一致性分析表明，从 IA 读数计算得出的平均动脉压低 31 点或高 28 点。具有如此大差异的偏差计算表明，IA 读数与 NIBP 之间相关性较差（R2 = 0.3027）。两组间血压调节药物的给药率无显著差异。
外科医生应根据具体情况考虑 IA 置管的风险和益处，尤其是对于年轻健康的患者。我们的研究结果强调了在接受 LE FTT 的患者中使用 IA 时更明确指导的必要性。
