两种术中保温措施干预对游离皮瓣移植血液循环的影响

The influence of two different intraoperative warming methods on the circulation of free flaps

目的：探讨术中2种保温措施干预对游离皮瓣血液循环的影响，从而选择对游离皮瓣移植血液循环最有利的术中保温措施，为术中护理提供临床依据。方法将96例欲行游离皮瓣移植患者，按随机数字表法分为常规保温组和多元化保温组各48例。常规保温组采用保温措施：术中维持常规手术室室温；冲洗液常规加温冲洗皮瓣。多元化保温组措施：提高术中室温及使用的各种冲洗液、消毒液温度；液体输入使用温液仪输入；术中使用手术床应铺置复温毯。观察2种保温护理措施对游离皮瓣移植血液循环的影响。结果常规保温护理组移植皮瓣的局部弹性、毛细血管充盈时间评分分别为（2.02±0.79）、（2.04±0.81）分；多元化保温护理组移植皮瓣的局部弹性、毛细血管充盈时间评分分别为（2.50±0.61）、（2.48±0.60）分，显著优于常规保温措施，2组比较差异有统计学意义（Z=1.949、3.872，均P＜0.05）。常规保温护理组临床预后皮瓣成活率为81.2%（39/48），多元化保温组临床预后皮瓣成活率为95.8%（46/48），显著优于常规保温护理组，2组比较差异有统计学意义（χ2=4.02，P＜0.05）。结论多元化保温护理较常规的保温护理可更有效促进游离皮瓣移植患者皮瓣局部血运和皮瓣成活，改善临床预后，促进术后康复，值得临床推广。

Objective To discuss the effect of two different warming methods on the circulation of&nbsp;free flaps during operation and seek for an optimal warming method which is benificial for the circulation of free flaps, and thus provide clinical evidences for intraoperative care. Methods A total of 96 patients undergoing free flap transplantation were divided into routine warming group and diversification warming group randomly (n=48 each). In routine warming group, temperature in the operating room was set at routine temperature and flaps were douched by routine heated saline. In diversification warming group, the temperature in the operation room, fluids used for washing wounds and flaps were warmed, fluids for intravenous application were pre-warmed by a fluid warmer, in addition, the operation table where patients were lying on was covered with warmer blanket. The influence of two different warming methods on the circulation of free flaps was observed. Results The scores of flap elasticity and capillary refill time in routine warming group were 2.02 ± 0.79 and 2.04 ± 0.81, respectively, vs. 2.50 ± 0.61 and 2.48 ± 0.6 in diversification warming group, showing diversification warming group was statistically better than routine warming group (Z=1.949, 3.872, P<0.05). In addition, the flap survival rate in routine warming group was 81.2%(39/48) vs. 95.8%(46/48) in diversification warming group, showing significantly better results in diversification warming group (χ2=4.02, P < 0.05). Conclusions The diversification warm keeping method can effectively promote the circulation and survival of flaps, improve clinical prognosis, accelerate postoperative rehabilitation, therefore is worthy of being recommanded its clinical application.