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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。
BACKGROUND & AIM: Perioperative anesthesia management is crucial to the success of free flap breast reconstruction. This study aimed to investigate fluid replacement, hemodynamics, and temperature management during breast reconstruction of the deep inferior epigastric perforator flap (DIEP). METHODS: A total of 126 patients undergoing DIEP breast reconstruction since June 2011-December 2015 were collected. Retrospective analysis of postoperative complications, intraoperative fluid infusion rate, mean arterial blood pressure (MAP) and central body temperature (T0) before anesthesia, T_1 before transplantation, Flap vascular anastomosis after 15 min (T_2), the end of surgery (T_3). Results: Flaps were found in 9 patients, of which 7 were successfully treated and 2 failed. The average intraoperative fluid rehydration rate was (5.44 ± 1.66) (m L · kg -1) / h. The MAP of T_0, T_1, T_2 and T_3 were (87.45 ± 8.90), (74.19 ± 8.63), (74.60 ± 8.71) and (79.62 ± 7.88) mm Hg, respectively. The central body temperature of T_0, T_1, T_2 and T_3 were (36.69 ± 0.14), (36.36 ± 0.18), (36.27 ± 0.14) and (36.21 ± 0.15) ℃, respectively. CONCLUSIONS: Researchers should establish standardized criteria for fluid replacement, hemodynamics, and temperature management in free-flap breast reconstruction to optimize skin flap outcomes.