面动脉切断后近、远心端动脉压力的测定和意义

The mesurement and significance of blood pressure of the retrograde and the anterograde flow in the facial artery

目的研究面动脉切断后近、远心端动脉是否具有恒定的血压,其远心端动脉血压能否为皮瓣的存活提供足够的血流基础。方法选择2017年3—7月中山大学孙逸仙纪念医院口腔癌患者25例(临床检查均已排除颈部淋巴结转移),所有患者术前告知此实验内容并同意接受此实验。于下颌骨下缘解剖充分暴露面动脉,并结扎沿途分支。于面动脉远心端距离下颌骨下缘下方约1 cm处剪断面动脉,置入动脉导针并连接动脉血压换能器,分别记录数值。此后结扎下唇动脉,观察血压变化情况,采用t检验评价面动脉近、远心端收缩压及舒张压两组数据间的差异性。结果远心端收缩压平均值为(88.00±17.46)mmHg(1 mmHg=0.133 kPa),远心端舒张压平均值为(60.33±7.49)mmHg,近心端收缩压平均值为(113.36±21.22)mmHg,近心端舒张压平均值为(68.80±11.63)mmHg。远心端收缩压为近心端77.68%,远心端舒张压为近心端88.43%,近、远心端收缩压(t=10.210,P<0.001)及近、远心端舒张压(t=6.643,P<0.001),两者差异均具有统计学意义。结扎下唇后面动脉远心端血压无明显波动。结论面动脉远心端的压力较近心端虽有所下降,但仍具有足够血压能够为组织瓣存活提供良好的血运。

Objective To study whether the proximal and distal facial artery have a constant bloodpressure after the facial artery is cut and whether the retrograde flow of the distal,paramandibular part ofthe facial artery would provide sufficient pressure to perfuse the flap for survival. Methods We seleted 25 oral squamous cell carcinoma cases from Mar. 2017 to July 2017 treated in Sun Yet-san Memorial Hospital(lymphatic metastasis was excluded). All patients were informed before surgery and agreed to accept theexperiment. We dissected the facial artery and occluded the branch of it,the facial artery was occludedwith two vessel clamps at the level of the mandible and prepared to allow for insertion of a standardintravenous polyethylene. The tube was connected to a pressure transducer. Arterial pressure and thepulsatile wave of the facial artery were recorded,and then with the ligation of the lower lip artery. Theblood pressure of retrograde and the anterograde in facial artery was recorded and analyzed. Results Themean systolic blood pressure in the distal facial atery was(88.00 ± 17.46)mmHg(1 mmHg = 0.133 kPa).The mean distolic blood pressure in the distal facial atery was(60.33 ± 7.49)mmHg. The mean systolicblood pressure in the proximal facial atery was(113.36 ± 21.22)mmHg. The mean distolic blood pressurein the proximal facial atery was(68.80 ± 11.63)mmHg. Systolic blood pressure arterial pressure in thedistal facial artery with retrograde flow was 77.68% of the anterograde arterial pressure. Diastolic bloodpressure arterial pressure in the distal facial artery with retrograde flow was 88.43% of the anterogradearterial pressure. The systolic blood pressure in the distal facial atery was compared with the systolic bloodpressure in the proximal facial atery(t = 10.210,P<0.001). The mean distolic blood pressure in the distalfacial atery was compared with the distolic blood pressure in the proximal facial atery(t= 6.643,P<0.001).After ligation of the lower lip artery,the blood pressure of the retrograde and the anterograde showed nosignificant fluctuations. Conclusions Although the retrograde blood pressure in the facial artery descendcompared to the anterograde,there is no significant difference between them. Thus,there is a good bloodflow basis for retrograde facial artery,which could provide good blood supply for tissue flap survival.