Sigurdsson G H, Banic A, Wheatley A M, Mettler D
Department of Anaesthesia and Intensive Care, University of Berne, Inselspital, Switzerland.
Br J Anaesth. 1994 Dec;73(6):826-32. doi: 10.1093/bja/73.6.826.
Hypoperfusion and necrosis in musculocutaneous flaps used for reconstruction of tissue defects is still a significant clinical problem. Although the causes of hypoperfusion are frequently surgical in nature, little is known about the effects of anaesthetic management on blood flow in flaps or the outcome of flap surgery. We compared in minipigs the effects of halothane and isoflurane anaesthesia in equipotent doses on microcirculatory blood flow (MBF) in the skin and muscle part of musculocutaneous flaps and also in intact (control) skin and muscle. Measurements were made during stable normovolaemic conditions and during mild to moderate hypovolaemia (withdrawal of 5%, 10% and 15% of total blood volume). Multi-channel laser Doppler flowmetry (LDF) was used to measure MBF and electromagnetic flowmetry (EMF) for total flap blood flow. During normovolaemic conditions there was no significant difference between the two groups in central haemodynamic or respiratory data. After 15% blood loss, however, there was a significant decrease in mean arterial pressure and cardiac output in the halothane group while there was no significant change in the isoflurane group (P < 0.05). MBF in control skin, control muscle and flap muscle remained approximately 10-15% higher in the isoflurane than in the halothane group throughout the study. In the isoflurane group, MBF in flap skin was unchanged during normovolaemia and there was less than 10% decrease during hypovolaemia. In the halothane group hypovolaemia caused a significant decrease in MBF in flap skin: 27% decrease after 5% blood loss, 45% decrease after 10% blood loss and 49% decrease after 15% blood loss compared with 5%, 20% and 21%, respectively, in intact skin.(ABSTRACT TRUNCATED AT 250 WORDS)
用于组织缺损重建的肌皮瓣低灌注和坏死仍是一个重大的临床问题。尽管低灌注的原因通常是手术相关的，但对于麻醉管理对皮瓣血流的影响或皮瓣手术结果知之甚少。我们在小型猪中比较了等效剂量的氟烷和异氟烷麻醉对肌皮瓣皮肤和肌肉部分以及完整（对照）皮肤和肌肉微循环血流（MBF）的影响。在稳定的正常血容量状态以及轻度至中度低血容量（抽取总血容量的5%、10%和15%）期间进行测量。使用多通道激光多普勒血流仪（LDF）测量MBF，使用电磁血流仪（EMF）测量皮瓣总血流。在正常血容量状态下，两组的中心血流动力学或呼吸数据无显著差异。然而，失血15%后，氟烷组的平均动脉压和心输出量显著下降，而异氟烷组无显著变化（P<0.05）。在整个研究过程中，异氟烷组对照皮肤、对照肌肉和皮瓣肌肉中的MBF比氟烷组高约10-15%。在异氟烷组中，正常血容量期间皮瓣皮肤的MBF不变，低血容量期间下降不到10%。在氟烷组中，低血容量导致皮瓣皮肤的MBF显著下降：失血5%后下降27%，失血10%后下降45%，失血15%后下降49%，而完整皮肤分别下降5%、20%和21%。（摘要截取自250字）
