Custer Philip L, Trinkaus Kathryn M
Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA.
Ophthalmic Plast Reconstr Surg. 2002 Nov;18(6):409-15. doi: 10.1097/00002341-200211000-00004.
To determine the incidence and risk factors of hemorrhagic complications associated with selected oculoplastic procedures.
A prospective study was performed to document the severity of intraoperative hemorrhage and postoperative bruising in patients undergoing oculoplastic procedures. The use of anticoagulant or platelet-inhibiting medications, systemic medical conditions, patient age, patient sex, and type of procedure were examined to identify risk factors for hemorrhagic complications.
Troublesome intraoperative bleeding prolonged surgery in 9.2% of cases. Severe bleeding with the potential to affect surgical outcome was encountered in 0.4% of procedures. There was little correlation between severity of bleeding and degree of postoperative bruising. Male sex, a history of heart disease, or age >60 years imparted a slightly greater risk of intraoperative bleeding. Age >60 years, hypertension, or recent cessation of aspirin may increase the risk of postoperative bruising. A history of previous stroke increased the risk of postoperative bleeding. There was no statistical difference in the incidence of hemorrhagic complications among patients currently treated with antiplatelet/anticoagulant agents, those who had stopped these medications before surgery, and those who were not treated with these agents. No patient had permanent sequelae related to hemorrhage. Two patients had postoperative systemic complications possibly attributable to withholding anticoagulant/antiplatelet medications in preparation for surgery.
Although serious hemorrhagic complications may be associated with oculoplastic procedures, the incidence of these complications is low. The decision to withhold antiplatelet or anticoagulant medications before surgery should be individualized. Selected procedures can be safely performed without stopping these agents.
确定与特定眼整形手术相关的出血性并发症的发生率及危险因素。
进行一项前瞻性研究，记录接受眼整形手术患者术中出血及术后瘀斑的严重程度。检查抗凝或血小板抑制药物的使用、全身疾病状况、患者年龄、患者性别及手术类型，以确定出血性并发症的危险因素。
9.2%的病例中，术中出血严重影响手术进程。0.4%的手术出现严重出血，可能影响手术结果。出血严重程度与术后瘀斑程度之间几乎没有相关性。男性、有心脏病史或年龄>60岁会使术中出血风险略有增加。年龄>60岁、高血压或近期停用阿司匹林可能增加术后瘀斑风险。既往有中风史会增加术后出血风险。目前正在接受抗血小板/抗凝药物治疗的患者、术前已停用这些药物的患者以及未接受这些药物治疗的患者，出血性并发症的发生率无统计学差异。没有患者因出血出现永久性后遗症。两名患者术后出现全身并发症，可能与术前停用抗凝/抗血小板药物有关。
尽管严重出血性并发症可能与眼整形手术相关，但这些并发症的发生率较低。术前停用抗血小板或抗凝药物的决定应个体化。某些手术在不停用这些药物的情况下也可安全进行。
