Private Çorlu REYAP Hospital, Rumeli University, Yeni Mahalle Mehmet Silivrili Caddesi No: 38, 34570, Silivri, Istanbul, Turkey.
Department of Anatomy, Yeditepe University, Faculty of Medicine, Inonu Mah. Kayisdagi Cad. No: 326A, 34755, Atasehir, Istanbul, Turkey.
Eur Arch Otorhinolaryngol. 2021 Jun;278(6):1899-1906. doi: 10.1007/s00405-020-06508-4. Epub 2021 Jan 2.
To compare the autonomic reflexes caused by inferior turbinate outfracture or bipolar cauterization for inferior turbinate reduction surgery.
The investigators designed and implemented a prospective study composed of 80 patients who underwent a septoplasty with inferior turbinate reduction. The predictor variable was the type of bilateral reduction operation and included inferior turbinate outfracture with a freer elevator and 20 watts bipolar cauterization for 15 s per side after septoplasty. The primary outcome variable was the intraoperative changes of the heart rate monitored preoperatively and 20 s, 1 min, and 4 min after the turbinate reduction procedure. Other variables were systolic and diastolic blood pressure alterations after the inferior turbinate outfracture or bipolar cauterization procedure. Descriptive and bivariate statistics were computed and the P-value was set at .05.
The sample was composed of 160 procedures in 80 patients grouped as follows: Outfracture (n = 100) and Cauterization (n = 60). There were no significant differences between the ages; grades of the turbinate hypertrophy; preoperative heart rates; and intraoperative 4th-minute heart rates, systolic and diastolic blood pressures. However, baseline systolic (p < 0.001) and diastolic (p < 0.001) blood pressures of the bipolar cauterization group were higher than outfracture group. Bipolar cauterization did not cause any significant changes in the heart rate, systolic and diastolic blood pressures. Inferior turbinate outfracture procedure caused a significant increase in heart rate (65.4 ± 9.82, p < 0.001), systolic (103 ± 8.62, p < 0.001) and diastolic (63.5 ± 7.37, p < 0.001) blood pressures.
The results of this study suggest that during the inferior turbinate outfracture procedure, it is important to closely monitor sympathetic and parasympathetic reflexes. The surgeon, and anesthesiologist, must be aware of the early stages of the autonomic reflexes during turbinate reduction.
比较下鼻甲外切术或双极电凝用于下鼻甲缩小手术引起的自主反射。
研究者设计并实施了一项前瞻性研究，共纳入 80 例行鼻中隔成形术伴下鼻甲缩小术的患者。预测变量为双侧缩小手术的类型，包括下鼻甲外切术和鼻中隔成形术后每侧 20 瓦双极电凝 15 秒。主要结局变量为术中监测的术前和鼻甲缩小术后 20 秒、1 分钟和 4 分钟的心率变化。其他变量为下鼻甲外切术或双极电凝术后收缩压和舒张压的变化。计算了描述性和双变量统计数据，P 值设为.05。
样本由 80 例患者的 160 例手术组成，分为外切术（n=100）和电凝术（n=60）两组。两组患者年龄、鼻甲肥大程度、术前心率和术中第 4 分钟心率、收缩压和舒张压均无显著差异。然而，双极电凝组的基线收缩压（p<0.001）和舒张压（p<0.001）均高于外切术组。双极电凝术并未引起心率、收缩压和舒张压的显著变化。下鼻甲外切术引起心率（65.4±9.82，p<0.001）、收缩压（103±8.62，p<0.001）和舒张压（63.5±7.37，p<0.001）显著升高。
本研究结果提示，在下鼻甲外切术过程中，密切监测交感和副交感反射非常重要。术者和麻醉师必须意识到鼻甲缩小过程中自主反射的早期阶段。
