摘要
目的:探讨多普勒超声血流动力学参数在评估穿支皮瓣存活中的应用价值。方法:选取2022年1月至2025年1月期间行穿支皮瓣移植术的80例患者作为研究对象,术后采用彩色多普勒超声检查皮瓣血流情况,测量皮瓣内穿支血管的收缩期峰值流速(Peak Systolic Velocity,PSV)、舒张末期流速(End-Diastolic Velocity,EDV)、阻力指数(Resistance Index,RI)、搏动指数(Pulsatility Index,PI),观察皮瓣的存活情况并比较不同类型穿支皮瓣的血流动力学参数。结果:术后共72例皮瓣存活,8例皮瓣坏死。存活皮瓣的PSV、EDV值高于坏死皮瓣,PI值低于坏死皮瓣(P<0.05),RI值在组间无差异(P>0.05);对存活皮瓣在术后第1、3、5、7 d的PSV、EDV值逐渐升高,PI值逐渐降低(P<0.05);PSV、EDV、PI对皮瓣坏死具有一定的预测价值,其受试者工作特性(Receiver Operating Characteristic,ROC)曲线下面积(Area under curve,AUC)分别为0.823、0.795、0.801。PSV、EDV、PI联合诊断的AUC为0.896,敏感度为87.5%,特异度为88.9%,不同类型穿支皮瓣的血流动力学参数存在差异,腹壁下动脉穿支皮瓣的PSV、EDV值高于股前外侧穿支皮瓣与腓动脉穿支皮瓣,PI值低于后两者(P<0.05)。结论:多普勒超声能够定量评估穿支皮瓣的血流动力学状态,其测量的PSV、EDV、PI等参数对皮瓣存活情况具有重要的预测价值,且不同类型穿支皮瓣的血流动力学特征存在差异。
Objective:To investigate the application value of Doppler ultrasound hemodynamic parameters in evaluating the survival of perforator flaps.Methods:Eighty patients who underwent perforator flap transplantation from January 2022 to January 2025 were selected.Postoperatively,color Doppler ultrasound was used to examine the flap's blood flow.The peak systolic velocity(PSV),end-diastolic velocity(EDV),resistance index(RI),and pulsatility index(PI)of the perforator vessels within the flap were measured,and flap survival was observed,the survival of the flaps and hemodynamic parameters of different types of transcutaneous flaps were also observed.Results:A total of 72 flaps survived and 8 flaps became necrotic.The PSV and EDV values of the surviving flaps were higher than those of the necrotic flaps,while the PI value was lower(P<0.05).There was no significant difference in RI between the groups(P>0.05).In surviving flaps,PSV and EDV values gradually increased,and PI values gradually decreased on postoperative days 1,3,5,and 7(P<0.05).PSV,EDV,and PI showed predictive value for flap necrosis,with Areas Under the Curve(AUC)of 0.823,0.795,and 0.801,respectively.The combined AUC of PSV,EDV,and PI was 0.896,with a sensitivity of 87.5%and a specificity of 88.9%.The hemodynamic parameters of different types of perforated skin flaps were different.The PSV and EDV values of subabdominal artery perforated skin flap were higher than those of anterior lateral femoral perforated skin flap and peroneal artery perforated skin flap,while the PI value was lower than those of the latter two(P<0.05).Conclusion:Doppler ultrasound can quantitatively assess the hemodynamic status of perforator flaps.Its measured parameters,such as PSV,EDV,and PI,have significant predictive value for flap survival,the hemodynamic characteristics of different types of perforated skin flap are different.
作者
林健
林金淼
颜炯灿
Lin Jian;Lin Jin-miao;Yan Jiong-can(Department of Ultrasound Medicine,Jinjiang Hospital(Fujian Hospital of Shanghai Sixth People's Hospital),Jinjiang 362200,Fujian,China)
基金
泉州市科技局计划项目(编号:NO.2021N042S)。
关键词
多普勒超声
穿支皮瓣
血流动力学
预测价值
Doppler ultrasound
Perforator flap
Hemodynamics
Predictive value
