Complication of Aggressive Fluid Administration in Free Flap Reconstruction of Head and Neck Surgery

過多術後靜脈輸液導致之頭頸癌腫瘤切除術後游離皮瓣重建手術之併發症

張耀仁(Yao-Jen Chang) ； 林育賢(Yu-Hsien Lin) ； 林煌基(Hwang-Chi Lin) ； 鄭舉緒(Chu-Hsu Jeng) ； 陳柵君(Cha-Chun Chen) ； 林上熙(Shang-Hsi Lin)

《臺灣整形外科醫學會雜誌》 28卷2期 (2019/06) Pp. 83-95

摘要

Background: The importance of comorbidities in free flap surgery has been increasingly receiving attention. Many predictors that influence free flap survival and perioperative complications have been discussed over the years. This study aimed to identify post-op predictors of free flap survival especially aggressive intravascular fluid hydration (IVF/BW/DAY＞45 ml/kg). Subjects and methods: A retrospective case series analysis was performed between 2010 and 2012 on 156 patients who underwent head and neck cancer ablation and microsurgical reconstruction. Demographic, surgical comorbidity, surgical, and peri-operative variable were analyzed via univariate and multivariate analyses. Results: Seventy-six patients developed minor or major complications. Six patients developed major complications (successful rate:96.2%), thirty-six patients (23.1%) minor surgical complications, and thirty-four patients (21.8%) resulted in medical complications. Significant post-op predictors of complications included aggressive crystalloid fluid hydration (IVF/BW/DAY≥45 ml/kg), intubation, and the use of anticoagulant drugs. More crystalloid fluid hydration was given in 2010 compared to 2012, and more medical complications occurred (P＜0.001). In the medical complication group, thirty-three (97%) underwent aggressive crystalloid fluid hydration (IVF/ BW/D≥45 ml/kg Odd ratio=1.52% P=0.3), and most of the patients (22) were diagnosed with pneumonia (22/34 64%). Conclusion: This retrospective study identified aggressive crystalloid fluid hydration (IVF/ BW/D≥45 ml/kg), intubation duration, and the use of anti-coagulant drugs as post-op complication predictors. We have demonstrated that aggressive fluid hydration could not increase the successful rate of free flap surgery, and may lead to complication in the other hand.

關鍵字

crystalloid fluid hydration ； head & neck reconstruction ； free flap

並列摘要

背景：頭頸部手術併發症的重要性已越來越受到關注。這些年下來，不少文獻針對可能影響游離皮瓣手術成功率的因子及手術併發症皆不斷有相關探討。本篇文章蒐集過去文獻中，頭頸癌游離皮瓣重建手術前、中、後影響皮瓣存活率之相關因子，經分析發現，術後靜脈輸液給予的過多（IVF/BW/D＞45ml/kg），可能會造成較顯著的術後併發症的產生。材料及方法：本篇文章採用回溯性分析，將2010至2012年156位同時接受頭頸癌腫瘤切除術後併接受游離皮瓣重建手術的病人，使用統計學方法多變異係數分析，分析病人族群，手術前後併發症。結果：一共76位病人在出院之前有發生過手術併發症，其中六位手術併發症影響到皮瓣的存活率（皮瓣成功率96.2%），當中的三十六位病人屬於輕微的手術併發症，另外的三十四位病人發生內科方面併發症。影響術後併發症的因子包含，過多的靜脈輸液補充（IVF/BW/D≥45ml/kg），插管，及抗凝劑的使用。相較於2012年病人的術後照顧，2010術後平均靜脈輸液較多，非但沒有提升皮瓣存活率，反而導致內科方面併發症較高出許多（P＜0.001）。在這些存有內科併發症病人當中，其中33（97%）位在靜脈輸液補充上每天每公斤超過45ml以上，而其中的27位中均於出院前診斷過有pneumonia。結論：本篇回溯性研究利用統計方法分析，得出術後靜脈輸液補充每天每公斤超過45ml，插管時間過長，術前使用過抗凝劑，均可能增加術後併發症的產生。然而過多術後靜脈輸液將導致併發症產生，也不會增加皮瓣存活率。