Harada Keisuke, Imamachi Noritaka, Matsuda Yuhei, Hirabayashi Masato, Saito Yoji, Kanno Takahiro
Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan.
Department of Anesthesiology, Saitama Medical University, Saitama, Japan.
J Korean Assoc Oral Maxillofac Surg. 2024 Apr 30;50(2):86-93. doi: 10.5125/jkaoms.2024.50.2.86.
Orthognathic surgery is a surgical procedure performed by intraoral approach with established and safe techniques; however, excessive blood loss has been reported in rare cases. In response, investigative efforts to identify methods to reduce the amount of blood loss have been made. Among such methods, the administration of tranexamic acid was reported to reduce the amount of intraoperative blood loss. However, few studies to date have reported the effect of tranexamic acid in orthognathic surgery under hypotensive anesthesia. The present study aimed to investigate the effect of the administration of tranexamic acid on intraoperative blood loss in patients undergoing bimaxillary (maxillary and mandibular) orthognathic surgery under hypotensive anesthesia.
A total of 156 patients (mean age, 27.0±10.8 years) who underwent bimaxillary orthognathic surgery under hypotensive anesthesia performed by the same surgeon between June 2013 and February 2022 were included in this study. The following data were collected from the medical records of each patient: background factors (age, sex, and body mass index), use of tranexamic acid, surgical procedures, previous medical history, duration of surgery, American Society of Anesthesiology physical status findings before surgery, intraoperative blood loss as a primary outcome, in-out balance, and blood test results. Descriptive statistics were calculated for statistical analysis, and a t -test and the chi-squared test were used for between-group comparisons. Group comparisons were performed after 1:1 propensity score matching to adjust for confounding factors. Statistical significance was set at <0.05.
Comparison between the groups based on the use of tranexamic acid revealed a significant difference in operation time. Propensity score matching analysis revealed that intraoperative blood loss was significantly lower in the tranexamic acid group.
The administration of tranexamic acid was effective in reducing intraoperative blood loss in patients undergoing bimaxillary orthognathic surgery under hypotensive anesthesia.
正颌外科手术是一种通过口内入路采用成熟且安全的技术进行的外科手术；然而，罕见情况下会出现失血过多的报道。对此，人们已展开研究以寻找减少失血量的方法。在这些方法中，据报道使用氨甲环酸可减少术中失血量。然而，迄今为止，很少有研究报道氨甲环酸在控制性低血压麻醉下的正颌外科手术中的效果。本研究旨在探讨在控制性低血压麻醉下接受双颌（上颌和下颌）正颌手术的患者中，使用氨甲环酸对术中失血量的影响。
本研究纳入了2013年6月至2022年2月期间由同一位外科医生进行控制性低血压麻醉下双颌正颌手术的156例患者（平均年龄27.0±10.8岁）。从每位患者的病历中收集以下数据：背景因素（年龄、性别和体重指数）、氨甲环酸的使用情况、手术操作、既往病史、手术时长、术前美国麻醉医师协会身体状况评估结果、作为主要结局指标的术中失血量、出入量平衡以及血液检查结果。计算描述性统计量用于统计分析，采用t检验和卡方检验进行组间比较。在进行1:1倾向评分匹配以调整混杂因素后进行组间比较。设定统计学显著性水平为<0.05。
基于氨甲环酸使用情况的组间比较显示手术时间存在显著差异。倾向评分匹配分析显示氨甲环酸组的术中失血量显著更低。
在控制性低血压麻醉下接受双颌正颌手术的患者中，使用氨甲环酸可有效减少术中失血量。
