Anesthesia Duration and Hypothermia Affect Graft Survival in Vascularized Free Flap Surgery

麻醉過久及術中低溫影響帶血管自由瓣之成活率

李隆億(Lung-I Lee) ； 林志中(Chih-Chung Lin) ； 陳明歧(Min-Chi Chen) ； 林志鴻(Chih-Hong Lin) ； 石明煌(Ming-Hwang Shyr)

《慈濟醫學雜誌》 17卷1期 (2005/02) Pp. 17-20

https://doi.org/10.6440/TZUCMJ.200502.0017

摘要

目的：決定自由瓣手術是否成功因素有許多，本研究目的是探討麻醉相關因素，特別針對術中體溫之影響。病人與方法：我們回顧一家醫學中心，自1995年一月至1999年十二月，由同一位外科醫師施行之336例自由瓣手術之病歷及麻醉紀錄單，去除紀錄不全及排除因子後得到311組病人資料，手術結果由同一位醫師評估，術後自由瓣缺血超過總面積四分之一定義為失敗，缺血總面積在五分之一以內定義為成功，兩者之間則定義為部分失敗。結果：311例中有240例（占77.2%）手術成功，有71例為失敗（占22.8%；其中3.5%為失敗，19.3%為部分失敗）。統計結果發現手術是否成功與病人性別、年齡、血色素質無關；而當麻醉時間超過8小時，或術中體溫低於34℃時成功率具有顯著統計意義，低於及高於34℃時失敗率（包括失敗及部分失敗個案）分別為57.14%以及22.83%。結論：由於所有手術均為同一外科醫師所施行，結果應能去除外科技巧之因素，本研究結論為過長麻醉時間及術中體溫低於34℃會影響自由瓣手術是否成功。

關鍵字

體溫 ； 整形外科手術 ； 外傷 ； 麻醉

並列摘要

Objective: The success rate of free flap revascularization is affected multifactorically. The aims of this study were to determine the anesthetic factors, with emphasis on hypothermia, in free flap failure and the relationship between hypothermia and free flap survival. Patients and Methods: We reviewed the anesthesia and medical records of patients undergoing free flap surgery from January 1995 to December 1999. The surgeries were all done by one surgeon in a medical center. During this period, 336 patients received free flap surgery. The data from 311 patients were collected and analyzed. The outcome of the surgery was evaluated and graded as successful, partially failed, or failed by the surgeon. Typically, an ischemic area larger than a quarter of the flap was rated as failed; between one fifth and a quarter of the area was rated as partially failed; and less than a fifth was rated as successful. Results: A total of 240 patients (77.2%) had successful flaps, while the other 71 patients (22.8%; 3.5% failed plus 19.3% partially failed) had failed ones. There were no statistical differences in gender, age, or hemoglobin level. Of note is that the total failure rate (partially failed plus failed cases) was significantly higher if the intra-operative body temperature was below 34℃ (57.14% vs 22.83%, respectively) or if the anesthesia duration was longer than 8 hours (P＜0.05). Conclusions: Anesthesia durations longer than 8h and intraoperative hypothermia below 34℃ might contribute to the failure of free flap surgery.

並列關鍵字

body temperature ； plastic surgery ； trauma ； anesthesia