Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.
Aesthet Surg J. 2011 Jul;31(5):493-500. doi: 10.1177/1090820X11411292.
In the facelift patient, uncontrolled perioperative hypertension is a difficult, acute condition that can lead to significant complications. Although the treatment of hypertension in the ambulatory medical setting has been standardized, its management in the cosmetic surgery setting has been ambiguous.
The authors evaluate the results of a survey to assess current national trends in perioperative facelift hypertension management.
A 13-question survey regarding perioperative hypertension management was sent by postal mail to 1776 members of the American Society for Aesthetic Plastic Surgery (ASAPS). Respondents were queried about their geographic location, caseload volume, facelift method, and hematoma rate.
A 35.4% response rate was attained (629 respondents). Superficial musculoaponeurotic system (SMAS) plication performed under general anesthesia as an outpatient procedure was the most common facelift technique. Perioperative blood pressure management was consistent among all respondents. Beta-blockers were commonly utilized throughout the preoperative period. Administration of alpha agonists was reported more frequently by surgeons with higher-volume caseloads and more years in practice. Reported hematoma rates did not vary with medication. Medical treatment at an intraoperative systolic blood pressure (SBP) threshold below 100 (p < .04) and a postoperative SBP of greater than 139 (p < .05) significantly increased reported hematoma rates.
The data generated from the survey suggest that the timing of treating hypertension deserves more attention than the actual medication administered. Proper perioperative care of the facelift patient is paramount in the reduction of hematoma rates. Preexisting hypertension correlates with a higher hematoma rate, though this study also suggests that normotensive anesthesia, as well as strict postoperative blood pressure control did contribute to a reduction in hematoma rate.
在面部提升患者中，无法控制的围手术期高血压是一种棘手的急性病症，可能导致严重的并发症。尽管门诊环境下高血压的治疗已经标准化，但在美容手术环境下的管理却存在模糊性。
作者评估了一项调查的结果，以评估当前全国范围内在面部提升手术期间高血压管理方面的趋势。
通过邮寄方式向美国美容整形外科学会（ASAPS）的 1776 名成员发送了一份关于围手术期高血压管理的 13 个问题的调查。受访者被询问其地理位置、手术量、面部提升方法和血肿率。
达到了 35.4%的回复率（629 名受访者）。在全身麻醉下进行的浅表肌肉筋膜系统（SMAS）折叠术作为门诊手术是最常见的面部提升技术。所有受访者的围手术期血压管理都一致。β受体阻滞剂在整个术前期间都被广泛使用。接受调查的医生中，手术量较大和从业年限较长的医生更常使用α受体激动剂。报告的血肿率与药物无关。术中收缩压（SBP）阈值低于 100 时进行药物治疗（p<.04）和术后 SBP 大于 139 时进行药物治疗（p<.05）显著增加了报告的血肿率。
从调查中得出的数据表明，治疗高血压的时机比实际给予的药物更值得关注。对面部提升患者进行适当的围手术期护理是降低血肿率的关键。高血压与较高的血肿率相关，但本研究还表明，正常血压的麻醉以及严格的术后血压控制确实有助于降低血肿率。
