Gruber Ronald P, Zeidler Kamakshi R, Berkowitz R Laurence
San Francisco, Calif. and Stanford, Calif. From the University of California, San Francisco; and Stanford University.
Plast Reconstr Surg. 2015 May;135(5):1337-1340. doi: 10.1097/PRS.0000000000001158.
Intraoperative bleeding during rhinoplasty makes it difficult to sculpt cartilages. Residual blood from a wet field can lead to induration, fibrosis, and definition loss. Recent studies with desmopressin (1-deamino-8-D-arginine vasopressin) to reduce blood loss in a variety of operations and minimize postoperative bleeding problems suggest using that drug routinely for elective rhinoplasty and not just for patients with coagulation issues.
Seventy-three consecutive rhinoplasty patients received desmopressin for the purpose of obtaining a dry operative field. The initial dose was 0.1 μg/kg. If the field was not as dry as desired, a second dose was given; if necessary, a third dose to a maximum of 0.3 μg/kg was given. All cases exhibited a satisfactorily dry field. There were no adverse effects. A retrospective comparison was made to 300 consecutive cases not receiving desmopressin.
Thirty of the 73 patients received a starting dose of 0.1 μg/kg and nothing more. Fourteen received a second dose of 0.1 μg/kg because the field was not as dry as desired and 29 received a third dose of 0.1 μg/kg because the field was not as dry as desired. All 73 patients exhibited a satisfactorily dry field, in contrast to 9 percent in the group not receiving desmopressin.
This study confirms the hemostatic effectiveness of desmopressin at lower than normally used doses in rhinoplasty. It also confirms its safety. It suggests its use in other procedures. A larger, carefully controlled study is indicated.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
鼻整形术中的术中出血会影响软骨塑形。湿手术视野中的残留血液会导致硬结、纤维化和轮廓消失。最近关于去氨加压素（1-去氨基-8-D-精氨酸加压素）用于减少各种手术中的失血并最小化术后出血问题的研究表明，该药物可常规用于择期鼻整形术，而不仅仅适用于有凝血问题的患者。
73例连续的鼻整形术患者接受去氨加压素以获得干燥的手术视野。初始剂量为0.1μg/kg。如果手术视野不如预期干燥，则给予第二剂；如有必要，给予第三剂，最大剂量为0.3μg/kg。所有病例的手术视野均令人满意地干燥。未出现不良反应。对300例连续未接受去氨加压素的病例进行回顾性比较。
73例患者中有30例接受了0.1μg/kg的起始剂量且未再增加剂量。14例因手术视野不如预期干燥而接受了第二剂0.1μg/kg，29例因手术视野不如预期干燥而接受了第三剂0.1μg/kg。所有73例患者的手术视野均令人满意地干燥，而未接受去氨加压素的组中这一比例为9%。
本研究证实了去氨加压素在低于正常使用剂量时用于鼻整形术的止血效果。同时也证实了其安全性。这表明其可用于其他手术。需要进行一项更大规模、严格对照的研究。
临床问题/证据水平：治疗性，III级。
