颌面部游离组织瓣移植术后血管危象发生的危险因素分析

刘畅; 张凯; 徐锦程; 吴志刚; 杨东昆; 胡凯

doi:10.13898/j.cnki.issn.1000-2200.2020.10.026

颌面部游离组织瓣移植术后血管危象发生的危险因素分析

Analysis of the risk factors of vascular crisis after free flap transplantation in oral and maxillofacial region

摘要

摘要:
目的探讨影响口腔颌面部游离组织瓣移植术后出现血管危象的危险因素。
方法对226例利用前臂皮瓣行口腔颌面部游离组织瓣移植术修补口腔肿瘤术后缺损病人的临床资料进行回顾性分析，收集病人的性别、年龄、是否出现血管危象、血管危象类型、糖尿病史、入院血糖值、高血压病史、入院平均血压值等临床资料，分析影响术后血管危象发生的危险因素。
结果226例病人中发生血管危象51例（22.6%），其中静脉危象41例，动脉危象10例。单因素分析显示，糖尿病史与血糖值偏高均为血管危象发生的影响因素（P < 0.01和P < 0.05），多因素二元logistic回归模型分析显示，糖尿病史为血管危象发生的危险因素（OR=4.646，P < 0.01）。
结论糖尿病病人出现游离皮瓣移植血管危象的风险较大，对于此类病人应该更加慎重应用游离组织瓣进行修复，当必须使用时，需术后时刻注意血管危象的发生，以保证皮瓣的成活。

Abstract:
ObjectiveTo explore the risk factors of vascular crisis after free flap transplantation in oral and maxillofacial region.
MethodsThe clinical data of 226 oral and maxillofacial defects patients repaired by free flap transplantation of forearm flap were retrospectively analyzed.The gender, age, absence or presence of vascular crisis, type of vascular crisis, history of diabetes mellitus, blood glucose level at admission, history of hypertension and average blood pressure at admission were collected, and the risk factors of postoperative vascular crisis were analyzed.
ResultsAmong 226 patients, the vascular crisis in 51 cases were identified, which included 41 cases with venous crisis and 10 cases with arterial crisis.The results of univariate analysis showed that the history of diabetes mellitus and high blood glucose were the influencing factors of the occurrence of vascular crisis(P < 0.01 and P < 0.05).The results of the multivariate logistic regression analysis showed that the history of diabetes mellitus was the risk factor of the occurrence of vascular crisis(OR=4.646, P < 0.01).
ConclusionThe risk of vascular crisis in diabetic patients treated with free flap transplantation is high.For such patients, the free flap should be cautiously used for repair.When it is necessary to use, it is necessary to pay attention to the occurrence of vascular crisis to ensure the survival of flap.

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