Maricevich Marco A, Adair Marcus J, Maricevich Renata L, Kashyap Rahul, Jacobson Steven R
Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Aesthetic Plast Surg. 2014 Aug;38(4):641-7. doi: 10.1007/s00266-014-0353-z. Epub 2014 Jun 10.
Hematoma remains the most challenging complication of facelifting and has been associated with male sex, hypertension, aspirin use, smoking, and high body mass index. Patients who underwent a facelift were studied to determine rates of hematoma and other complications and to identify predictive and protective factors, including meticulous analysis of perioperative blood pressure.
Charts of patients who underwent a facelift from 2003 to 2011 at our institution were retrospectively reviewed. Demographic, clinical, and procedural data were collected. All postoperative complications were recorded. Data from continuous blood pressure monitoring in the operating and recovery rooms were obtained from a perioperative database and stratified by median and peak values. Logistic regression was used for data analysis.
Of the 229 patients included, the majority were female (88.2 %), mean age at presentation was 62 years, and 35.8 % had hypertension. Postoperative complications occurred in 60 patients (26.2 %). The most common complication was unfavorable scar (7.4 %), followed by hematoma (6.5 %). Male sex (P = 0.02), history of hypertension (P = 0.04), preoperative systolic blood pressure (SBP) greater than 160 mmHg (P = 0.04), and operating room peak SBP greater than 165 mmHg (P = 0.04) were predictive factors for hematoma. Recovery room peak SBP greater than 150 mmHg (P = 0.09) was also associated with hematoma. On multivariate analysis, only male sex and preoperative SBP greater than 160 mmHg remained independent risk factors for hematoma.
This study is unique in that it compares the rate of hematoma to continuous blood pressure data in the operating and recovery rooms stratified by median and peak values. Meticulous control of perioperative SBP is recommended for a safe facelift. History of hypertension, increased SBP at admission, and increased perioperative peak SBP are predictors for postoperative hematoma.
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血肿仍然是面部提升术中最具挑战性的并发症，且与男性、高血压、服用阿司匹林、吸烟以及高体重指数相关。对接受面部提升术的患者进行研究，以确定血肿及其他并发症的发生率，并识别预测因素和保护因素，包括对围手术期血压的细致分析。
对2003年至2011年在本机构接受面部提升术的患者病历进行回顾性研究。收集人口统计学、临床和手术数据。记录所有术后并发症。手术室和恢复室连续血压监测数据从围手术期数据库中获取，并按中位数和峰值分层。采用逻辑回归进行数据分析。
纳入的229例患者中，大多数为女性（88.2%），就诊时平均年龄为62岁，35.8%患有高血压。60例患者（26.2%）发生术后并发症。最常见的并发症是瘢痕不理想（7.4%），其次是血肿（6.5%）。男性（P = 0.02）、高血压病史（P = 0.04）、术前收缩压（SBP）大于160 mmHg（P = 0.04）以及手术室峰值SBP大于165 mmHg（P = 0.04）是血肿的预测因素。恢复室峰值SBP大于150 mmHg（P = 0.09）也与血肿相关。多因素分析显示，只有男性和术前SBP大于160 mmHg仍然是血肿的独立危险因素。
本研究的独特之处在于，它将血肿发生率与手术室和恢复室按中位数和峰值分层的连续血压数据进行了比较。建议对面部提升术进行围手术期SBP的细致控制以确保安全。高血压病史、入院时SBP升高以及围手术期峰值SBP升高是术后血肿的预测因素。
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