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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。
Objective: To monitor preoperative and postoperative oxygen saturation (SO2) by using near infrared spectroscopy and to summarize the changes of SO2 in donor area after forearm radial flap preparation, and to explore the relationship between forearm radialis skin Effect of flap preparation on donor blood supply. Methods: Thirty-five patients with forearm flap preparation were selected clinically as the forearm flaps for the monitoring sites. From 1 day before surgery to 7 days after operation, SO2 in donor and donor sites was monitored by near infrared spectroscopy (TSAH-100), once every 4 hours after 24 hours, 24 hours after surgery twice a day until the 7th day after surgery. SPSS13.0 software package was used to paired t-test of SO2 in great and small intestine to analyze the difference between them. Results: The changes of SO2 in large and small intertrochanteric forearm flaps were from lower than the contralateral level to higher than the contralateral level, and then gradually decreased to the initial level before surgery. The donor intertidal area SO2 peaked at 20 h after operation, which was significantly different from the contralateral small intestine (P <0.05). SO2 in the donor area reached a peak at 24 hours after operation, with a significant difference at 12 hours and 48 hours after operation (P <0.05). On the 7th day after operation, there was no significant difference in the SO2 in the large intertidal zone and the small intertidal zone (P> 0.05). Conclusion: The preparation of radial forearm flap has a certain degree of influence on the blood supply of donor tissue. In the absence of radial artery and head vein variability, the radial artery and ulnar artery between the branch of circulation to ensure forearm radial flap for the area after the perfusion, blood supply in 6 ~ 7 days after surgery Within the basic return to preoperative status.