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硬膜外麻醉对下肢微血管重建中游离皮瓣动脉很大流速的影响

2022-02-19 MedSci原创 MedSci原创

游离皮瓣存活的关键因素之一是维持充足的灌注。作者评估了硬膜外麻醉对下肢微血管重建中游离皮瓣动脉最大流速的影响。

游离皮瓣存活的关键因素之一是维持充足的灌注。作者评估了硬膜外麻醉对下肢微血管重建中游离皮瓣动脉最大流速的影响。

这是一项前瞻性随机研究,患者被分配接受联合全身硬膜外麻醉(硬膜外组,n=26)或单独全身麻醉(对照组,n=26)。

图1文章来源

研究者在硬膜外注射表面活性物质罗哌卡因10ml后,应用超声技术分析其对游离皮瓣动脉最大流速的影响。主要结果测量是建立基线30分钟后的动脉最大流速。还评估了术中血流动力学和术后结果,如术后疼痛、阿片类药物需求、手术并发症、重症监护病房入院和住院时间。

图2下肢重建患者接受显微游离皮瓣手术的时间和顺序示意图

结果显示,实验操作开始测量30分钟后,硬膜外组的动脉最大流速显著高于硬膜外组(35.3±13.9厘米/秒,而非23.5±8.4厘米/秒;p=0.001)。

图3对照组和硬膜外组在基线测量后30分钟的动脉最大流速比较

硬膜外组术后1小时的疼痛评分以及术后1小时和6小时的阿片类药物需求量显著低于硬膜外组[3.0(四分位范围,2.0至5.0)与5.0(四分位范围,3.0至6.0),p=0.019;0.0μg(四分位范围,0.0至50.0μg)与50.0μg(四分位范围,0至100.0μg),p=0.005;46.9μg(四分位区间,0.0至66.5μg)与96.9μg(四分位区间,41.7至100.0μg),p=0.014)。

两组在术中血流动力学或其他术后结果方面没有显著差异。

硬膜外麻醉增加了游离皮瓣的动脉最大流速,减少了术后疼痛和对阿片类药物的需求。

这些结果表明,硬膜外麻醉可能对皮瓣蒂动脉血流和术后疼痛产生有效影响,并且在用于下肢重建的显微游离皮瓣手术中,维持足够的皮瓣灌注是一个很好的选择。

原始文章:

Park Jun-Young,Suh Hyunsuk Peter,Kwon Jin Geun et al. Epidural Anesthesia and Arterial Maximal Flow Velocity of Free Flap in Patients Having Microvascular Lower Extremity Reconstruction: A Randomized Controlled Trial.[J] .Plast Reconstr Surg, 2021, undefined: undefined.

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    2022-02-17 mgqwxj
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    2022-02-17 sunylz

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