应用近红外光谱监测前臂皮瓣供区术后血运变化

Preliminary study of blood flow changes in the donor site of radial forearm flap with near-infrared spectroscopy

目的：利用近红外光谱技术对前臂皮瓣供区术前及术后的血氧饱和度（SO2）进行监测,总结前臂桡侧皮瓣制备术后供区SO2的变化规律,探讨前臂桡侧皮瓣制备术对供区血运的影响。方法：临床上接受前臂皮瓣制备术的患者35例,选择前掌大鱼际、小鱼际作为前臂皮瓣供区监测部位。自术前1天至术后第7天,用近红外光谱血氧检测仪（TSAH-100）对供区和对侧相同监测部位的SO2进行监测,术后24 h内每4 h 1次,术后24 h后每天2次,持续至术后第7天。采用SPSS13.0软件包对大鱼际和小鱼际的SO2进行配对t检验,分析两者之间的差异。结果：前臂皮瓣供区大鱼际和小鱼际的SO2均呈现由低于对侧水平上升至高于对侧水平,然后逐渐下降至术前初始水平的变化特点。供区小鱼际SO2在术后20 h达到峰值,与对侧小鱼际相比有显著差异（P〈0.05）。供区大鱼际SO2在术后24 h达到峰值,术后12 h和术后48 h与对侧相差幅度较大,有显著差异（P〈0.05）。术后第7天,供区大鱼际和小鱼际SO2较对侧无显著差异（P〉0.05）。结论：前臂桡侧皮瓣制备术对其供区组织的血运产生了一定程度的影响。在无桡动脉和头静脉变异的情况下,桡动脉与尺动脉之间的交通支循环能保证前臂桡侧皮瓣术后供区的血流灌注量,其血运在术后6~7 d内基本恢复至术前状态。

PORPUSE： To investigate changes of blood oxygen saturation in the donor site of radial forearm flap both preoperatively and postoperatively with near-infrared spectroscopy technique,and discuss the influence of elevation of radial forearm flap on the donor site＇ blood flow.METHODS： Thirty-five patients who received unilateral elevation of radial forearm flap were involved,the pre-and postoperative blood oxygen saturation of thenar and hypothenar in donor site and contra-lateral forearm were measured by near-infrared oximeter（TSAH-100）,in the following manner one time per 4 hours in the first 24 hours,then twice per day after the first 24 hours till the seventh day postoperatively.The data was compared between SO2 values of hypothenar and thenar with paired t test using SPSS13.0 software package.RESULTS： Blood oxygen saturation of thenar and hypothenar in donor site both increased from lower level to higher level when compared with contra-lateral forearm,and then decreased gradually to the preoperative level.Blood oxygen saturation of hypothenar of donor site reached peak value at 20-hour after operation and had significant difference with the value of contra-lateral hypothenar.While the blood oxygen saturation of thenar of donor site reached peak value at 24-hour after operation and had significant difference with the contra-lateral thenar at 12-hour and 48-hour postoperatively.However,blood oxygen saturation of thenar and hypothenar of donor site had no significant difference when compared with contra-lateral forearm on the seventh day postoperatively.CONCLUSIONS： The elevation of radial forearm flap produced minor influence on the blood flow of donor site.With no variation of radial artery and cephalic vein,the collateral circulation between radial artery and ulnar artery can afford the blood supply of donor site postoperatively till the blood flow returned to preoperative level at the sixth or seventh day postoperatively.Supported by Capital Medical Development Scientific Research Fund（2009-3039）.