Ratio of Blood Glucose Level Change Measurement for Flap Monitoring
Ratio of Blood Glucose Level Change Measurement for Flap Monitoring
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DOI：
10.1097/gox.0000000000001851
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发表时间：
2018-07-01
影响因子：
1.5
通讯作者：
Iida, Takuya
中科院分区：
文献类型：
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作者：
Karakawa, Ryo;Yoshimatsu, Hidehiko;Iida, Takuya
背景：在瓣充血的情况下，早期发现和快速再探查是重要的。一些研究描述了血糖测量在皮瓣监测中的作用。1然而，该方法的灵敏度和特异度还不够高，不足以决定是否进行再探查。本研究的目的是评价和建立一种利用血糖水平变化率(RBGC)检测静脉血栓形成的方法，并提出充血后皮瓣挽救的算法。方法：测量36例游离组织移植术后一段时间的血糖水平，并计算RBGC。当怀疑为瓣膜充血时，按照一定的算法进行频繁的血糖检测和相应的对策。如果怀疑静脉血栓，则进行再次探查。结果：36个皮瓣中，30个皮瓣无静脉血栓形成，6个皮瓣有静脉血栓形成。4个皮瓣有充血迹象，但在重新探查后有所改善。检测到静脉血栓形成的时间点的平均RBGCs为。7.61 mg/dl h，无静脉血栓时为0.10 mg/dl h，前者显著低于后者。结论：采用RBGC测量的皮瓣监测方法，可以挽救部分皮瓣静脉血栓形成所致的充血，而不需要重新探查。
Background: In a setting of flap congestion, early detection and rapid reexploration are important. Some studies described the efficacy of blood glucose measurement for flap monitoring. 1 However, the sensitivity and specificity of this method were not high enough to determine whether reexploration should be done or not. The purpose of this study was to evaluate and establish a method using the ratio of blood glucose level change (RBGC) measurement for detecting venous thrombosis and to propose an algorithm for flap salvage after congestion.Methods: Blood glucose level was measured in 36 free tissue transfers over time postoperatively and RBGC was calculated. When flap congestion was suspected, frequent blood glucose measurement and some countermeasures were performed complying with an algorithm. If the venous thrombus was suspected, the reexploration was performed. The RBGCs at the points in time when the venous thrombosis was detected were compared with those at the points in time when the flap demonstrated no venous thrombosis.Results: Of the 36 flaps, 30 flaps demonstrated no venous thrombosis and 6 flaps demonstrated venous thrombosis. Four flaps demonstrated signs of congestion but improved after the reexploration. The mean RBGCs at the points in time when the venous thrombosis was detected was. 7.61 mg/dl h and those at times when the flap demonstrated no venous thrombosis was 0.10 mg/dl h, the former being significantly lower than the latter.Conclusion: Using the flap monitoring method using RBGC measurement, we could salvage some flaps from the congestion due to the venous thrombosis without unnecessary reexploration.