Ghodraty Mohamadreza, Khatibi Ali, Rokhtabnak Faranak, Maleki Mojtaba, Parsa Fatemeh
Anesthesia Department, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
Otolaryngology Department, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
Anesth Pain Med. 2017 Oct 25;7(5):e13677. doi: 10.5812/aapm.13677. eCollection 2017 Oct.
Uncontrolled bleeding during surgery is one of the main predisposing factors for failure of the surgeon and complications following rhinoplasty. The current study aimed at comparing the effects of nitroglycerine and labetalol on the induction of controlled hypotension and bleeding volume during septorhinoplasty.
The current randomized, controlled, clinical trial enrolled 60 patients candidate for septorhinoplasty at Firoozgar hospital in Tehran, Iran, in 2 equal groups receiving either 0.1 to 1 mcg/kg/minute nitroglycerine or 2 to 4 mg/minute labetalol to achieve a mean arterial blood pressure of about 60 to 65 mmHg. In case the targeted blood pressure was not achieved, isoflurane was added. Degree of bleeding was evaluated by the volume of suctioned blood and the blood remaining in surgical gauzes. Additionally, the surgeon's satisfaction with the surgical field was evaluated by a scoring system. The collected data were, then, compared between the study groups by the statistical methods.
Based on the current study findings, systolic (P < 0.001), diastolic (P = 0.002), and the mean arterial blood pressures (P < 0.001) were significantly lower in the nitroglycerine group. Ninety percent of the patients in the labetalol group received isoflurane to achieve the targeted blood pressure defined as controlled hypotension. There was no significant difference between the groups regarding the volume of bleeding (P = 0.75); however, the surgeons were more satisfied with nitroglycerine than labetalol (P < 0.001).
It was concluded that nitroglycerine had a better effect, in comparison to labetalol, on inducing the controlled hypotension in septorhinoplasty.
手术中出血失控是鼻整形手术失败及术后并发症的主要诱发因素之一。本研究旨在比较硝酸甘油和拉贝洛尔在鼻中隔鼻整形术中诱导控制性低血压及减少出血量方面的效果。
本随机对照临床试验纳入了伊朗德黑兰菲罗兹加尔医院60例拟行鼻中隔鼻整形术的患者，将其分为两组，每组30例，分别接受0.1至1微克/千克/分钟的硝酸甘油或2至4毫克/分钟的拉贝洛尔治疗，以使平均动脉血压维持在60至65毫米汞柱左右。若未达到目标血压，则加用异氟烷。通过吸引出的血量及手术纱布上残留的血量评估出血程度。此外，采用评分系统评估外科医生对手术视野的满意度。然后通过统计学方法比较研究组之间收集的数据。
根据本研究结果，硝酸甘油组的收缩压（P < 0.001）、舒张压（P = 0.002）及平均动脉血压（P < 0.001）显著更低。拉贝洛尔组90%的患者接受了异氟烷以达到定义为控制性低血压的目标血压。两组间出血量无显著差异（P = 0.75）；然而，外科医生对硝酸甘油的满意度高于拉贝洛尔（P < 0.001）。
得出的结论是，与拉贝洛尔相比，硝酸甘油在鼻中隔鼻整形术中诱导控制性低血压方面效果更佳。
