乳腺癌游离皮瓣乳房重建术后的麻醉管理

发布时间：2018-06-12 07:53

本文选题：乳房重建 + 游离皮瓣　；参考：《中国癌症杂志》2016年05期

【摘要】：背景与目的:围术期的麻醉管理对游离皮瓣乳房重建术成功与否至关重要。该研究拟探讨游离腹壁下深血管穿支皮瓣(deep inferior epigastric perforator flap,DIEP)乳房重建术中的补液、血流动力学以及体温管理。方法:收集自2011年6月—2015年12月共126例接受DIEP乳房重建术的患者资料。回顾性分析患者术后并发症、术中补液速度、以下时点的平均动脉血压(mean arterial blood pressure,MAP)和中心体温:麻醉诱导前(T0)、皮瓣切取完毕移植前(T_1)、皮瓣血管吻合完毕后15 min(T_2),手术结束(T_3)。结果:9例患者发生皮瓣危象,其中7例解救成功,2例失败。术中平均补液速度为(5.44±1.66)(m L·kg-1)/h。T_0、T_1、T_2和T_3的MAP分别为(87.45±8.90)、(74.19±8.63)、(74.60±8.71)和(79.62±7.88)mm Hg。T_0、T_1、T_2和T_3的中心体温分别为(36.69±0.14)、(36.36±0.18)、(36.27±0.14)和(36.21±0.15)℃。结论:研究者应该针对游离皮瓣乳房重建术中的补液、血流动力学以及体温管理建立规范化标准,以优化皮瓣转归。
[Abstract]:Background and purpose: perioperative anesthesia management is very important for the success of free flap breast reconstruction. The study is to explore the rehydration, hemodynamics and temperature management in the reconstruction of deep inferior epigastric perforator flap (DIEP). Methods: from June 2011 to 2015, 12 A total of 126 patients received DIEP breast reconstruction. The postoperative complications, the rate of intraoperative rehydration, the average arterial blood pressure (mean arterial blood pressure, MAP) and central temperature at the following point: before anesthesia induction (T0), the skin flap before transplantation (T_1), 15 min (T_2) after the complete anastomosis of the skin flap, and the end of the operation (T_) 3) results: in 9 cases, the skin flap crisis occurred in 9 cases, of which 7 cases were successfully rescued and 2 cases failed. The average fluid filling speed was (5.44 + 1.66) (m L. Kg-1) /h.T_0, T_1, T_2 and T_3 MAP were respectively (87.45 + 8.90), (74.19 + 8.63), (74.60 + 8.71) and (79.62 +) mm Hg.T_0, T_1, respectively. .14) and (36.21 + 0.15) C. Conclusion: the researchers should establish standardized standards for the rehydration, hemodynamics and temperature management of free flap breast reconstruction in order to optimize the turnover of the skin flap.
【作者单位】：复旦大学附属肿瘤医院麻醉科复旦大学上海医学院肿瘤学系;复旦大学附属肿瘤医院乳腺外科复旦大学上海医学院肿瘤学系;美国德克萨斯大学M.D.Anderson癌症中心整形外科;
【基金】：徐舸先生的科研基金资助
【分类号】：R737.9;R614

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