PDF(Pubmed)
Abstract：
BACKGROUND: In head and neck reconstructive surgery, postoperative complications are a well-known concern.
METHODS: We examined 46 patients who underwent ablative surgery and received fibula free flap reconstruction. The main focus was to assess the influence of intraoperative blood pressure fluctuations and the administration of inotropic drugs on complications, either related to the flap or systemic, serving as the primary endpoint.
RESULTS: Utilizing logistic regression models, we identified that intraoperative mean arterial blood pressure (MAP) drops did not correlate with the occurrence of either flap-related complications (MAP < 70, p = 0.79; MAP < 65, p = 0.865; MAP < 60, p = 0.803; MAP < 55, p = 0.937) or systemic medical complications (MAP < 70, p = 0.559; MAP < 65, p = 0.396; MAP < 60, p = 0.211; MAP < 55, p = 0.936). The occurrence of flap-related complications significantly increased if a higher dosage of dobutamine was administered (median 27.5 (IQR 0-47.5) vs. 62 (38-109) mg, p = 0.019) but not if norepinephrine was administered (p = 0.493). This correlation was especially noticeable given the uptick in complications associated with fluid overload (3692 (3101-4388) vs. 4859 (3555-6216) mL, p = 0.026).
CONCLUSIONS: Intraoperative and immediate postoperative blood pressure fluctuations are common but are not directly associated with flap-related complications; however, dobutamine application as well as fluid overload may impact flap-specific complications.
METHODS: We examined 46 patients who underwent ablative surgery and received fibula free flap reconstruction. The main focus was to assess the influence of intraoperative blood pressure fluctuations and the administration of inotropic drugs on complications, either related to the flap or systemic, serving as the primary endpoint.
RESULTS: Utilizing logistic regression models, we identified that intraoperative mean arterial blood pressure (MAP) drops did not correlate with the occurrence of either flap-related complications (MAP < 70, p = 0.79; MAP < 65, p = 0.865; MAP < 60, p = 0.803; MAP < 55, p = 0.937) or systemic medical complications (MAP < 70, p = 0.559; MAP < 65, p = 0.396; MAP < 60, p = 0.211; MAP < 55, p = 0.936). The occurrence of flap-related complications significantly increased if a higher dosage of dobutamine was administered (median 27.5 (IQR 0-47.5) vs. 62 (38-109) mg, p = 0.019) but not if norepinephrine was administered (p = 0.493). This correlation was especially noticeable given the uptick in complications associated with fluid overload (3692 (3101-4388) vs. 4859 (3555-6216) mL, p = 0.026).
CONCLUSIONS: Intraoperative and immediate postoperative blood pressure fluctuations are common but are not directly associated with flap-related complications; however, dobutamine application as well as fluid overload may impact flap-specific complications.
摘要：
背景：在头颈部重建手术中，术后并发症是众所周知的问题.
方法：我们检查了46例接受切除手术并接受腓骨游离皮瓣重建的患者。主要重点是评估术中血压波动和使用正性肌力药物对并发症的影响，要么与皮瓣有关，要么与全身有关，作为主端点。
结果：利用逻辑回归模型，我们发现术中平均动脉血压（MAP）下降与皮瓣相关并发症的发生（MAP<70，p=0.79；MAP<65，p=0.865；MAP<60，p=0.803；MAP<55，p=0.937）或全身医学并发症（MAP<70，p=0.559；MAP<65，p=0.396；MAP<60，p=0.211；MAP<55，p=0.955）。如果使用较高剂量的多巴酚丁胺，皮瓣相关并发症的发生率显着增加（中位数27.5（IQR0-47.5）与62(38-109)mg,p=0.019），但如果使用去甲肾上腺素则不是（p=0.493）。考虑到与液体超负荷相关的并发症的增加，这种相关性尤其明显（3692（3101-4388）与4859(3555-6216)毫升,p=0.026)。
结论：术中和术后即刻的血压波动是常见的，但与皮瓣相关的并发症并不直接相关；然而，多巴酚丁胺的应用以及液体超负荷可能会影响皮瓣特异性并发症。
方法：我们检查了46例接受切除手术并接受腓骨游离皮瓣重建的患者。主要重点是评估术中血压波动和使用正性肌力药物对并发症的影响，要么与皮瓣有关，要么与全身有关，作为主端点。
结果：利用逻辑回归模型，我们发现术中平均动脉血压（MAP）下降与皮瓣相关并发症的发生（MAP<70，p=0.79；MAP<65，p=0.865；MAP<60，p=0.803；MAP<55，p=0.937）或全身医学并发症（MAP<70，p=0.559；MAP<65，p=0.396；MAP<60，p=0.211；MAP<55，p=0.955）。如果使用较高剂量的多巴酚丁胺，皮瓣相关并发症的发生率显着增加（中位数27.5（IQR0-47.5）与62(38-109)mg,p=0.019），但如果使用去甲肾上腺素则不是（p=0.493）。考虑到与液体超负荷相关的并发症的增加，这种相关性尤其明显（3692（3101-4388）与4859(3555-6216)毫升,p=0.026)。
结论：术中和术后即刻的血压波动是常见的，但与皮瓣相关的并发症并不直接相关；然而，多巴酚丁胺的应用以及液体超负荷可能会影响皮瓣特异性并发症。
