Lenzen C, Trobisch H, Loch D, Bull H G
Klinik für MKG-Chirurgie/Plastische Operationen, Krefeld-Uerdingen.
Mund Kiefer Gesichtschir. 1999 Nov;3(6):314-9. doi: 10.1007/s100060050162.
The hemodynamic parameters of 95 patients undergoing maxillary or bimaxillary orthognathic surgery in 1996 and 1997 at the Department of OMF Surgery/Plastic Surgery, Krefeld, Germany, were analyzed retrospectivly to study the effect of intraoperative blood loss.
The parameters included the blood loss volume, age, weight and sex of the patients, the mode of osteotomy and the operation time, the surgeon, the average blood pressure, the infusion volume, the anesthesiologist, the thrombocyte counts and their function, the activity of the coagulation factors II, V, VII, VIII, IX, X, XI, XII, XIII and von-Willebrand-factor, and the pathological coagulation factor counts of each patient, the rate of autologous blood donation and the rate of retransfusion. Statistical analysis was done using the Speraman-Rhotest.
The average blood loss during maxillary osteotomy was 670 +/- 380 ml and during bimaxillary surgery 1120 +/- 510 ml. Men lost about 300 ml more than women. Operations of more than 3.5 h in length led to a blood loss of 1200 +/- 520 ml as opposed to 670 +/- 310 ml. The average blood loss among various surgeons was between 670 ml and 1180 ml of various anesthesiologists between 730 ml and 1200 ml, without statistical evidence. Some 17.9% of patients showed pathological thrombocytic function concerning medication with aspirin; 34.7% had pathological activities of coagulation factors, but only 2.1% with clinical significance.
Mode of operation, maxillary or bimaxillary, und length of operation were the most significant factors of intraoperative blood loss. Patients with pathological coagulation had nearly the same rate of blood loss as patients with physiological coagulation. In most cases this was determined by restriction of aspirin. Analysis of the rate of autologous blood retransfusion showed a significant correlation to blood loss in bimaxillary surgery. Maxillary osteotomy led to a retransfusion of only 14.2% of autologous blood unit. This should be reviewed critically especially concerning costs.
对1996年和1997年在德国克雷费尔德口腔颌面外科/整形外科接受上颌或双颌正颌手术的95例患者的血流动力学参数进行回顾性分析，以研究术中失血的影响。
参数包括患者的失血量、年龄、体重和性别、截骨方式和手术时间、外科医生、平均血压、输液量、麻醉医生、血小板计数及其功能、凝血因子II、V、VII、VIII、IX、X、XI、XII、XIII和血管性血友病因子的活性以及每位患者的病理性凝血因子计数、自体血捐献率和再输血率。采用斯皮尔曼等级相关检验进行统计分析。
上颌截骨术中平均失血量为670±380ml，双颌手术中为1120±510ml。男性比女性多失血约300ml。手术时间超过3.5小时导致失血量为1200±520ml，而手术时间较短时为670±310ml。不同外科医生的平均失血量在670ml至1180ml之间，不同麻醉医生的平均失血量在730ml至1200ml之间，无统计学差异。约17.9%的患者因服用阿司匹林出现病理性血小板功能；34.7%的患者凝血因子活性异常，但只有2.1%具有临床意义。
手术方式（上颌或双颌）和手术时间是术中失血的最重要因素。凝血功能异常的患者与凝血功能正常的患者失血量几乎相同。在大多数情况下，这是由阿司匹林的使用限制决定的。自体血再输血率分析显示，其与双颌手术中的失血量显著相关。上颌截骨术导致自体血单位再输血率仅为14.2%。这一点应进行严格审查，尤其是在成本方面。
