Oki Yamato, Hatakeyama Hiromitsu, Yamamoto Kouzi, Hukui Kenta, Yamada Shota, Natsumi Kizima, Iwamura Tai, Matsumoto Yu, Sato Kaname, Oridate Nobuhiko
Otolaryngology, Yokohama City University Medical Center, Yokohama, JPN.
Clinical Statistics, Yokohama City University Graduate School of Medicine, Yokohama, JPN.
Cureus. 2024 Dec 23;16(12):e76286. doi: 10.7759/cureus.76286. eCollection 2024 Dec.
The safety and efficacy of endoscopic sinus surgery have improved with the development of new equipment and improved surgical techniques. However, it is accompanied by the risk of complications. Intraoperative blood loss is an important factor in the safe conduct of surgery. Therefore, we examined the factors associated with intraoperative blood loss.
The amount of intraoperative bleeding experienced by 518 patients with sinonasal disease who underwent endoscopic sinus surgery under general anaesthesia at our hospital over nine years was tabulated. Thirty-four variables were extracted after analysis of patients' background, sinonasal pathology, and haematology results. Multivariate linear regression analysis was performed.
Multivariate analysis revealed significant differences in the prothrombin time-international normalized ratio (PT-INR), Lund-Mackay score, operative time, and initial versus repeat surgery. The degree of change between the 25% and 75% points was significant for the following variables: an increase from 5 to 14 points for the Lund-Mackay score at 73 mL.
Preoperative precautionary measures should be implemented in the event of re-operation, expected prolonged operative time, high Lund-Mackay score, and prolonged PT-INR. Intraoperative blood loss in patients with a high Lund-Mackay score requires meticulous attention.
随着新设备的研发和手术技术的改进，鼻内镜手术的安全性和有效性有所提高。然而，它也伴随着并发症的风险。术中失血是手术安全进行的一个重要因素。因此，我们研究了与术中失血相关的因素。
将我院9年间518例接受全身麻醉下鼻内镜手术的鼻窦疾病患者的术中出血量制成表格。在分析患者的背景、鼻窦病理和血液学结果后提取了34个变量。进行多变量线性回归分析。
多变量分析显示凝血酶原时间国际标准化比值（PT-INR）、Lund-Mackay评分、手术时间以及初次手术与再次手术之间存在显著差异。以下变量在第25百分位数和第75百分位数之间的变化程度显著：Lund-Mackay评分从5分增加到14分时，出血量为73毫升。
对于再次手术、预期手术时间延长、Lund-Mackay评分高和PT-INR延长的情况，应采取术前预防措施。Lund-Mackay评分高的患者术中失血需要密切关注。
