彩色多普勒超声在游离皮瓣移植术后皮瓣血液循环护理观察中的应用

Application of color Doppler ultrasound in nursing observation of flap vascular circulation after free flap transplantation

目的总结彩色多普勒超声(CDU)在游离皮瓣移植术后皮瓣血液循环护理观察中的临床应用价值。方法2018年9月至2020年11月,对温州医科大学附属第二医院18例游离皮瓣移植治疗肢体皮肤缺损患者按肤色、皮温、皮肤软组织张力、毛细血管反应时间以及应用CDU对皮瓣血液循环状态进行监测。发现血液循环障碍时,进行扩容补液,局部按摩,抗凝,改善微循环治疗。皮瓣下积极引流预防感染,配合高压氧治疗,准确及时发现血管危象和避免皮瓣坏死。结果术后CDU监测发现2例出现区域性血液循环障碍;1例出现皮瓣的主干血管和皮瓣内穿支血管完全栓塞,皮瓣经削薄后改为全厚皮肤植皮,深部组织外露区域术后经换药后愈合;1例出现皮瓣回流静脉的不全栓塞,经手术探查后静脉危象解除,皮瓣完全成活。结论游离皮瓣移植术后需全面观察,结合4项常规血液循环指标,CDU监测皮瓣血流情况可以提供更为客观准确和细致的血液循环状态依据,能早期准确地发现游离皮瓣移植术后的血液循环障碍,并了解皮瓣内的血流状态,有效避免血管危象的继续进展,避免皮瓣坏死,提高皮瓣成活率。

Objective To summarize the clinical application value of color Doppler ultrasound(CDU)in the nursing observation of flap vascular circulation after free flap transplantation.Methods From September 2018 to November 2020,18 patients with skin defect of limbs treated by free flap transplantation in the Second Affiliated Hospital of Wenzhou Medical University were monitored by skin color,skin temperature,skin tension,capillary reaction time and CDU.When the vascular circulation disorder was found,the patients should be treated with volume expansion,rehydration,local massage of the flap,anticoagulation and microcirculation improvement.Positive drainage under the flap to prevent infection,combined with hyperbaric oxygen treatment,accurate and timely exploration of vascular crisis to avoid flap necrosis.Results Postoperatively,CDU monitoring found that 2 cases had regional vascular circulation disorder,1 case had complete embolization of the main vessels and perforators in the flap,the flap was thinned and changed to full thickness skin grafting,the deep tissue exposed area was healed by dressing change,and 1 case had incomplete embolization of the flap′s reflowing vein.After operation,the venous crisis was relieved and the flap survived completely.Conclusions Comprehensive observation is needed after free flap transplantation.Combined with four routine vascular circulation indexes,CDU monitoring of flap blood flow can provide more objective,accurate and detailed basis for vascular circulation status,and can accurately find the vascular circulation disorder after free flap transplantation in early stage,and understand the vascular flow status of the flap,so as to effectively avoid the continuous progress of vascular crisis,to avoid flap necrosis and improve the survival rate of flap.