术中血管加压剂的使用是否与头颈部游离组织移植手术皮瓣失效有关？

IF 2 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Stomatology Oral and Maxillofacial Surgery Pub Date : 2025-09-04 DOI:10.1016/j.jormas.2025.102540

Yi Zhou , Jie Zhang , Zhenzhen Li , Xiaodong Wang , Yun Liu , Xudong Yang

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引用次数: 0

摘要

背景：在头颈部游离组织移植手术中保持适当的血压对器官和皮瓣的灌注都很重要。然而，使用血管加压药物治疗术中低血压是有争议的。本前瞻性队列研究的目的是评估术中血管加压药物对皮瓣坏死发生率的影响。方法：本前瞻性队列研究调查了2020年1月至2021年12月在北京大学口腔医学院和医院接受头颈部自由组织移植手术的患者。排除标准包括术前放疗史或吸烟史，以及美国麻醉医师协会（ASA）身体状态分类IV或v。预测变量为术中血管加压药物的使用，并据此分组。结果变量为早期皮瓣全坏死（术后7天内或出院前皮瓣失效）。采用单因素logistic回归分析确定早期皮瓣坏死的潜在危险因素。然后进行多因素回归分析，对潜在的混杂因素进行顺序调整，以确定这些因素是否与皮瓣坏死独立相关。同时对患者按年龄、性别分层进行线性回归分析，探讨危险因素与皮瓣预后的关系。结果：共有239名受试者入组，其中血管加压素组121人，无血管加压素组118人。年龄、ASA分级、Charlson合病指数、皮瓣缺血时间组间差异有统计学意义。在单因素分析中，尽管血管加压剂的使用（优势比[OR]， 1.65； 95%可信区间[CI]， 0.39-7.07; P = 0.499）与皮瓣坏死无显著相关性，但手术时间（OR, 1.01; 95% CI, 1.01-1.01; P = 0.001）和皮瓣缺血时间（OR,1.02; 95% CI, 1.01-1.03; P = 0.006）与皮瓣坏死有显著相关性。平滑曲线拟合结果显示，手术时间和皮瓣缺血时间与皮瓣坏死呈线性正相关。结论：头颈部游离皮瓣转移术中血管加压药物的使用与早期皮瓣失败无关。试验注册：本研究已在中国临床试验注册中心注册（ChiCTR2100043119）。

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Is the use of intraoperative vasopressors associated with flap failure in head and neck free tissue transfer surgery?

Background

Maintaining appropriate blood pressure during head and neck free tissue transfer surgery is important for both organ and flap perfusion. However, the use of vasopressors to treat intraoperative hypotension is controversial. The purpose of this prospective cohort study is to evaluate the impact of intraoperative vasopressors on the incidence of flap necrosis.

Methods

This prospective cohort study examined patients undergoing free tissue transfer surgery of the head and neck between January 2020 and December 2021 at Peking University School and Hospital of Stomatology. Exclusion criteria included history of preoperative radiotherapy or smoking and American Society of Anesthesiologists (ASA) physical status classification IV or V. The predictor variable was intraoperative vasopressor use and patients were grouped accordingly. The outcome variable was early total flap necrosis(flap failure within 7 days of the operation or before discharge). Univariate logistic regression was used to determine potential risk factors for early flap necrosis. Multivariate regression analyses with sequential adjustment for potential confounding factors was then performed to determine whether these factors were independently associated with flap necrosis. Meanwhile, linear regression analyses were performed with patients stratified according to age and sex to explore the relationship between risk factors and flap outcome.

Results

A total of 239 participants were enrolled, with 121 in the vasopressor group and 118 in the no vasopressor group. Age, ASA classification, Charlson comorbidity index, and flap ischemia duration significantly differed between the groups. Although vasopressor use (odds ratio [OR], 1.65; 95 % confidence interval [CI], 0.39–7.07; P = 0.499) was not significantly associated with flap necrosis in univariate analysis, operation duration (OR, 1.01; 95 % CI, 1.01–1.01; P = 0.001] and flap ischemia duration (OR,1.02; 95 % CI, 1.01–1.03; P = 0.006) were. The smooth curve fitting results demonstrated that both operation duration and flap ischemia duration had a positive linear correlation with flap necrosis.