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首页> 外文期刊>The Laryngoscope: A Medical Journal for Clinical and Research Contributions in Otolaryngology, Head and Neck Medicine and Surgery, Facial Plastic and Reconstructive Surgery .. >Immediate postoperative extubation in patients undergoing free tissue transfer.
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Immediate postoperative extubation in patients undergoing free tissue transfer.

机译：进行游离组织转移的患者术后立即拔管。

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OBJECTIVES/HYPOTHESIS: Extubation (cessation of ventilatory support) is often delayed in free flap patients to protect the microvascular anastomosis, presumably by reducing emergence-related agitation. We sought to determine if immediate extubation in the operating room (OR) would improve the postoperative course compared to delayed extubation in the intensive care unit (ICU). STUDY DESIGN: Retrospective chart review. METHODS: Medical records of all patients undergoing free tissue transfer for head and neck reconstruction between January 2009 and July 2010 were reviewed (n = 52). Patients extubated immediately postoperatively in the OR (immediate group, n = 26) were compared to patients extubated in the ICU (delayed group, n = 26). RESULTS: Tobacco use, alcohol use, pulmonary history, case length, and free flap type were not significantly different between the two groups. Although the average ICU stay for the immediate group was significantly shorter than the delayed group (2.0 days vs. 3.4 days; P = .008), the reduction in overall hospital stay for the immediate group did not achieve statistical significance (8.2 days vs. 9.5 days; P = .21). Use of treatment for agitation (27% vs. 65%) and physical restraints (8% vs. 69%) were significantly lower in the immediate versus delayed group (P = .01 and P < .001, respectively). Although flap-related, surgical, and medical complication rates were not significantly different between the two groups, the delayed extubation group had a significantly higher incidence of pneumonia (15% vs. 0%; P = .05). CONCLUSIONS: Immediate postoperative extubation in the OR following head and neck microvascular free tissue transfer reduces ICU stay, anxiolytic use, restraint use, and incidence of pneumonia without an increase in flap- or wound-related complications.
机译：目的/假设：游离皮瓣患者通常会延迟拔管（停止通气支持）以保护微血管吻合，大概是通过减少与出苗相关的躁动。我们试图确定与重症监护室（ICU）的延迟拔管相比，在手术室（OR）即时拔管是否会改善术后过程。研究设计：回顾性图表审查。方法：回顾了2009年1月至2010年7月间所有接受自由组织转移进行头颈部重建的患者的病历（n = 52）。将手术后立即拔管的患者（立即组，n = 26）与在ICU拔管的患者（延迟组，n = 26）进行了比较。结果：两组的吸烟，饮酒，肺部病史，病例长度和游离皮瓣类型无显着差异。尽管即刻治疗组的平均ICU住院时间明显少于延迟治疗组（2.0天比3.4天; P = .008），但即刻治疗组的总住院时间却没有统计学意义（8.2天vs.。 9.5天; P = 0.21）。即刻治疗组和延迟治疗组的躁动疗法（27％vs. 65％）和身体约束（8％vs. 69％）显着降低（分别为P = .01和P <.001）。尽管两组之间皮瓣相关，手术和医学并发症的发生率没有显着差异，但延迟拔管组的肺炎发生率明显更高（15％比0％; P = 0.05）。结论：头颈部微血管游离组织转移后，OR术后立即拔管可减少ICU停留时间，抗焦虑药使用，限制使用和肺炎的发生，而不会增加皮瓣或伤口相关并发症的发生。

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