Gaziosmanpasa University, Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, 60100 Tokat, Turkey.
J Craniomaxillofac Surg. 2013 Mar;41(2):124-8. doi: 10.1016/j.jcms.2012.06.003. Epub 2012 Jul 12.
The aim of this retrospective study was to evaluate the efficacy of dexamethasone with controlled hypotension on intraoperative bleeding and postoperative morbidity in rhinoplasty.
Sixty rhinoplasty patients required hump resection and lateral osteotomy were included in this study. The patients were randomized into four groups. In group I (n=15), a single dose of 10mg/kg dexamethasone was intravenously administered at the beginning of the operation. In group II (n=15), the patients were given 2 doses of 10mg/kg intravenously dexamethasone at the beginning of the operation, and 24 hours after the operation. In group III (n=15), 3 doses of 10mg/kg intravenously dexamethasone were given at the beginning of the operation, before osteotomy and 24 hours after the operation. Group IV (n=15) was assigned as control group and the patients were neither administered dexamethasone nor applied hypotension. All cases in groups I, II and III were operated under controlled hypotension. Systolic arterial pressure was aimed to keep between 65 and 75 mmHg for controlled hypotensive anaesthesia. Controlled hypotension was achieved by a remifentanil infusion of 0.1-0.5 microg/kg/min, following a bolus of 1 microg/kg. Degree of eyelid oedema and periorbital soft-tissue ecchymosis was evaluated separately using a scale of 0-4. Intraoperative blood loss was recorded for each patient. Patients were evaluated at 24 hours and postoperative days 2, 5, 7, and 10.
In groups I, II and III, intraoperative bleeding was more decreased and the operation time was significantly shorter compared with control group (P<0.001). Eyelid oedema and periorbital ecchymosis were significantly decreased in groups I, II and III at the following postoperative 7 and 10 days (P<0.001). There was statistically significant difference between group III and other groups at the postoperative 5 and 7 days in lower eyelid oedema (P<0.001), upper and lower eyelid ecchymosis (P<0.001 and 0.004, respectively). There were no postoperative complications with using steroid in any of the groups.
Three doses of dexamethasone with controlled hypotension considerably reduced postoperative morbidities of rhinoplasty with osteotomy as well as intraoperative bleeding. Thus, in group III receiving 3 doses of steroid, when compared to other groups, more uneventful postoperative period were provided for surgeon and the patients.
本回顾性研究旨在评估在鼻整形术中使用地塞米松联合控制性降压对术中出血和术后发病率的疗效。
本研究纳入了 60 例需要行驼峰切除和外侧截骨的鼻整形术患者。患者被随机分为四组。在组 I（n=15）中，患者在手术开始时静脉注射 10mg/kg 地塞米松单次剂量。在组 II（n=15）中，患者在手术开始时和术后 24 小时静脉注射 2 次 10mg/kg 地塞米松。在组 III（n=15）中，患者在手术开始时、截骨前和术后 24 小时静脉注射 3 次 10mg/kg 地塞米松。组 IV（n=15）为对照组，患者既未给予地塞米松也未应用降压。组 I、II 和 III 中的所有病例均在控制性降压下进行手术。收缩压的目标范围为 65-75mmHg，以实现控制性降压麻醉。通过 0.1-0.5μg/kg/min 的瑞芬太尼输注和 1μg/kg 的推注来实现控制性降压。采用 0-4 分制评估眼睑水肿和眶周软组织瘀斑的程度。记录每位患者的术中出血量。患者在术后 24 小时和第 2、5、7、10 天进行评估。
与对照组相比，组 I、II 和 III 的术中出血量减少，手术时间显著缩短（P<0.001）。在术后第 7 天和第 10 天，组 I、II 和 III 的眼睑水肿和眶周瘀斑明显减轻（P<0.001）。在术后第 5 天和第 7 天，组 III 与其他组在眼睑水肿（P<0.001）、上睑和下睑瘀斑（P<0.001 和 0.004）方面有统计学显著差异。在任何一组中，使用类固醇均未出现术后并发症。
在接受控制性降压的情况下，地塞米松三联治疗可显著减少鼻整形术伴截骨术的术后并发症和术中出血。因此，与其他组相比，在接受三联类固醇治疗的组 III 中，为术者和患者提供了更顺利的术后恢复期。
