Intraoperative anesthetic management in breast cancer patients undergoing free flap breast reconstruction

楼菲菲; 许平波; 黄乃思

doi:10.3969/j.issn.1007-3969.2016.05.005

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Intraoperative anesthetic management in breast cancer patients undergoing free flap breast reconstruction

更新时间：2025-12-31

- Intraoperative anesthetic management in breast cancer patients undergoing free flap breast reconstruction
- China Oncology Vol. 26, Issue 5, Pages: 383-387(2016)
- 作者机构：
  
  1. 复旦大学附属肿瘤医院麻醉科，复旦大学上海医学院肿瘤学系,上海,200032
  2. 复旦大学附属肿瘤医院乳腺外科，复旦大学上海医学院肿瘤学系,上海,200032
- 作者简介：
- 基金信息：
- DOI：10.3969/j.issn.1007-3969.2016.05.005
  CLC：
- Published Online：23 June 2016，
  
  Published：23 June 2016
- 稿件说明：
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楼菲菲,许平波,黄乃思,等. 乳腺癌游离皮瓣乳房重建术后的麻醉管理[J]. 中国癌症杂志, 2016, 26(5): 383-387.

楼菲菲, 许平波, 黄乃思. Intraoperative anesthetic management in breast cancer patients undergoing free flap breast reconstruction[J]. China Oncology, 2016, 26(5): 383-387.
楼菲菲,许平波,黄乃思,等. 乳腺癌游离皮瓣乳房重建术后的麻醉管理[J]. 中国癌症杂志, 2016, 26(5): 383-387. DOI： 10.3969/j.issn.1007-3969.2016.05.005.

楼菲菲, 许平波, 黄乃思. Intraoperative anesthetic management in breast cancer patients undergoing free flap breast reconstruction[J]. China Oncology, 2016, 26(5): 383-387. DOI： 10.3969/j.issn.1007-3969.2016.05.005.

摘要

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(T

)、皮瓣切取完毕移植前(T

)、皮瓣血管吻合完毕后15 min(T

)，手术结束(T

)。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) (mL·kg

-1

)/h。T

、T

和T

的MAP分别为(87.45±8.90)、(74.19±8.63)、(74.60±8.71)和(79.62±7.88) mmHg。T

、T

和T

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。

Abstract

Background and purpose: Perioperative anesthetic management is thought to be critical to the success of free flap breast reconstruction. The purpose of this study was to discuss intraoperative fluid

hemodynamic and temperature management in patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction. Methods: From Jun. 2011 to Dec. 2015

126 patients underwent DIEP flap breast reconstruction. Postoperative complications were reviewed. Intraoperative fluid infusion rate was analyzed. Me

an arterial blood pressure (MAP) and core temperature were measured before induction (T

)

after flap elevation but before flap transfer (T

)

15 min after flap revascularization (T

)

and at the end of surgery (T3). Results: Nine patients developed flap compromised: 7 were salvaged and 2 failed. The mean intraoperative fluid infusion rate was (5.44±1.66) (mL•kg

-1

)/h. MAP at T

and T

were (87.45±8.90)

(74.19±8.63)

(74.60±8.71) and (79.62±7.88) mmHg

respectively. Core temperature at T

and T

were (36.69±0.14)

(36.36±0.18)

(36.27±0.14) and (36.21±0.15) ℃

respectively. Conclusion: Standard practice focusing on intraoperative fluid management

hemodynamic adjustment and temperature control in microsurgical reconstruction of the breast should be established to further improve free flap outcome.

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复旦大学附属肿瘤医院乳腺外科，上海市乳腺肿瘤重点实验室，复旦大学上海医学院肿瘤学系

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