遊離空腸を用いた咽頭再建術の周術期管理における動脈圧心拍出量モニターの有用性

Usefulness of Arterial Pressure-based Cardiac Output Monitoring in Perioperative Management of Pharyngeal Reconstruction with Free Jejunal Flap

要旨

　遊離空腸を用いた咽頭再建術は，開腹操作を伴う長時間手術であるため，適切な輸液管理が重要である。同手術における動脈圧心拍出量モニター（フロートラック^®，Edwards Lifesciences，米国，以下F）の有用性を後ろ向きに検討した。咽頭再建術64症例69回中F使用群（24回）はF未使用群（45回）に比べ，術中の晶質液量，水分出納バランスは少なく，ICU滞在時間は短かった。Fは咽頭再建術の術中輸液制限と術後経過改善に有用である。

　Background：Patients undergoing pharyngeal reconstruction with free jejunal flap need careful fluid management because of prolonged surgical manipulation including laparotomy. FloTrac, an arterial pressure-based cardiac output monitoring, might be useful for preventing excessive or insufficient fluid balance during surgery. We retrospectively examined the effect of FloTrac on perioperative management and postoperative course in patients undergoing pharyngeal reconstruction.

　Methods：Sixty-four patients undergoing pharyngeal reconstruction（69 times including reoperations）were enrolled in this study. A comparison of parameters was made between patients treated with or without FloTrac（24 times vs. 45 times）.

　Results：Patients treated with FloTrac had lower intraoperative crystalloid fluid volume and balance, and shorter intensive care unit stay.

　Conclusions：The use of FloTrac in pharyngeal reconstruction may reduce fluid balance and improve postoperative course.