“五点”皮瓣温度和“单点”皮瓣温度预测血管危象的准确性及临界值研究

• 作者： 蒋琪霞 ¹ 朱玉玲 ¹ 祝文君 ² 李秀芸 ¹ 谢郝婷 ¹ 王华军 ¹ 袁斯明 ¹
• 作者单位：
  1.  210002 江苏省南京市，解放军东部战区总医院烧伤整形科
  2.  661199 云南省红河州个旧市，红河州第一人民医院伤口造口治疗中心
• 通讯作者： 袁斯明 
• 提交时间：2023-11-16

摘要: 背景皮瓣移植是手术修复各类伤口的常用方式，皮瓣温度反映了皮瓣的血液供应和静脉回流状况，有助于早期发现血管危象，但如何准确测量皮瓣温度及其对血管危象的具体预测作用尚不明确。目的 探讨五点和单点皮瓣温度差异及其预测血管危象的准确性与最佳临界值。方法 纳入2021年1月~2023年7月接受皮瓣手术的成年住院患者，从手术后第1天开始，每2小时一次采用非接触式红外线测温仪按照皮瓣中心点、边缘12点、3点、6点、9点的五点法测量皮瓣温度，距离每个部位3cm停顿3秒获取温度读数，取五点温度的平均值，与皮瓣中心点的单点温度比较，同时采用棉签压迫法监测皮瓣的毛细血管反应，观察皮瓣颜色，连续监测5天。结果 共纳入66例各类皮瓣手术患者，男、女各占59.09%（39/66）和40.91%（27/66），平均年龄（45.1716.77）岁，手术后1-5天的五点皮瓣温度和单点皮瓣温度的变化规律均为术后第1天温度最低，此后逐渐升高。血管危象发生率为15.15%，主要发生于手术后3天内，五点皮瓣温度低于单点皮瓣温度（P<0.001）。绘制五点皮瓣温度和单点皮瓣温度预测血管危象的受试者工作特征曲线，结果显示五点皮瓣温度预测血管危象的曲线下面积为0.87（95%CI：0.74，0.99），灵敏度和特异度为90%和75%，约登指数为0.65，最佳临界值为35.96℃；单点皮瓣温度预测血管危象的曲线下面积为0.76（95%CI：0.61，0.91），灵敏度和特异度为70%和71%，约登指数为0.41，最佳临界值为36.18℃。结论 五点皮瓣温度低于单点皮瓣温度，前者预测血管危象的准确性和真实性稍优于后者，临床采用五点法测量的皮瓣温度更准确。

Abstract: BackgroundSkin flap transplantation is a common method for surgical repair of various types of wounds. The temperature of the skin flap reflects the blood supply and venous reflux of it，which can help detect vascular crises in the early stage. However，how to accurately measure the temperature of skin flap and its specific predictive role in vascular crises remains unclear. ObjectiveTo explore the difference in flap temperature between the five point and single point flaps and their accuracy and optimal cut-off values in predicting vascular crisis. MethodsAdult inpatients who underwent flap transplantation surgery from January 2021 to July 2023 were included. Beginning on day 1 after surgery，non-contact infrared thermometers were used every 2 hours to measure the skin flap temperature using the five points method at the center point，edge at 12 o'clock，3 o'clock，6 o'clock，and 9 o'clock of the skin flap，the temperature readings were obtained by pausing for 3 seconds at a distance of 3cm from each site，and the average temperature of the five points was taken to compare with the center single point temperature of the skin flap. The cotton buds-press method was simultaneously used to monitor the capillary response of the skin flap and observe the color of skin flap for 5 consecutive days. ResultsA total of 66 patients with various types of skin flap surgeries were included，with males and females accounting for 59.09%（39/66），39/66 and 40.91% （27/66），respectively. The average age was （45.1716.77） years. The changes of the five point flap temperature and the single point flap temperature from 1-5 days after surgery were the lowest on the first day after surgery，and gradually increased thereafter. The incidence of vascular crisis was 15.15% （n=10） and，which occurred mainly within 3 days after surgery，and the five-point flap temperature was lower than the single-point flap temperature（P<0.001）. The receiver operating characteristic（ROC） curves of five-point flap temperature and single point flap temperature predicting vascular crisis were plotted and the results showed that the area under curve（AUC） of five points flap temperature predicting vascular crisis was 0.87 （95%CI: 0.74-0.99），the sensitivity and specificity were 90% and 75%，the Youden index was 0.65，and the optimal cut-off value was 35.96 ℃ . The AUC of single point flap temperature predicting vascular crisis was 0.76 （95%CI0.61-0.91），the sensitivity and specificity were 70% and 71%，the Youden index was 0.41，and the optimal cut-off value was 36.18℃ . ConclusionThe five points flap temperature was lower than that of the single point flap temperature，the accuracy and authenticity of the former is slightly better than the latter in predicting vascular crisis.

• 分类： 医学、药学 >> 预防医学与公共卫生学
• 引用： ChinaXiv:202311.00142 (或此版本 ChinaXiv:202311.00142V1)
  DOI:10.12074/202311.00142V1
  CSTR:32003.36.ChinaXiv.202311.00142.V1
• 推荐引用方式： 蒋琪霞,朱玉玲,祝文君,李秀芸,谢郝婷,王华军,袁斯明.(2023).“五点”皮瓣温度和“单点”皮瓣温度预测血管危象的准确性及临界值研究.中国全科医学.doi:10.12074/202311.00142V1 (点此复制)