بررسي و مقايسه ميزان از دست دادن خون حين انواع مختلف جراحي ارتوگناتيك

Evaluation and Comparison of Blood Loss during Different Ortognathic Surgeries

ﻣﻘﺪﻣﻪ: ﺗﺨﻤﻴﻦ دﻗﻴﻖ ﻣﻴﺰان اﺗﻼف ﺧﻮن ﺣﻴﻦ ﺟﺮاﺣﻲ هاي ارﺗﻮﮔﻨﺎﺗﻴﻚ دوﻓﻜﻲ ﺟﻬﺖ ﭘﻴﺶ ﺑﻴﻨﻲ ﻧﻴﺎز ﺑﻪ ﺗﺰرﻳﻖ خون يا ﻓﺮآورده هاي خوني ﺑﺮاي ﺟﺮاح و ﻣﺘﺨﺼﺺ ﺑﻴﻬﻮﺷﻲ اﻫﻤﻴﺖ دارد. ﻫﺪف اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺗﻌﻴﻴﻦ ﻣﻴﺰان اﺗﻼف ﺧﻮن ﺣﻴﻦ انواع مختلف ﺟﺮاﺣﻲ هاي ارﺗﻮﮔﻨﺎﺗﻴﻚ ﺑﻮد. مواد و روش ها: تعداد 92 بيمار در دو گروه يك فك و دوفك وارد مطالعه شدند.جراحي ها در بيمارستان قائم (عج) مشهد و تحت بيهوشي با كم فشاري القايي انجام شد. فشار خون حين جراحي در حد متعادل زير 100 ميلي متر حفظ شد. ميزان خونريزي حين عمل با اندازه گيري ساكشن و شمارش گازها توسط تيم بيهوشي صورت پذيرفت و در پايان عمل ثبت شد. در پايان، ميزان خونريزي با تفكيك نوع جراحي مشخص و داده ها با آزمون من-ويتني مورد بررسي قرار گرفت. يافته ها: تعداد 92 بيمار، با ميانگين سني 3/64±23/6سال جامعه مورد مطالعه را تشكيل مي داد. ميانگين ميزان اتلاف خون كلي 351/63 ميلي ليتر به دست آمد. آزمون من ويتني نشان داد كه ميزان خونريزي هم در يك فك و هم در دو فك درگير در كلاس II به طور معني داري بيشتر از كلاس III بود (به ترتيب برابر p=0/008 و p=0/040) ميزان خونريزي در جراحي هاي تك فك به طور معني داري كمتر از دو فك بود (براي هر دو p<0/001). نتيجه گيري:با توجه به مطالعه حاضر ميزان خونريزي در ميان انواع جراحي هاي ارتوگناتيك بسته به نوع جراحي و تعداد عمل متفاوت مي باشد، اﻳﻦ ﻓﺎﻛﺘﻮرها در ﺗﺨﻤﻴﻦ ﻣﻴﺰان اﺗﻼف ﺧﻮن و ﺗﻌﻴﻴﻦ و ﭘﻴﺶ ﺑﻴﻨﻲ اﻗﺪاﻣﺎت ﻻزﻣﻪ ﺟﻬﺖ ﺟﺎﻳﮕﺰﻳﻨﻲ ﺣﺠﻢ از دﺳﺖ رﻓﺘﻪ ﻣﺆﺛﺮ اﺳﺖ.

Introduction: Accurate estimation of the amount of blood loss for predicting the need for transfusion during bimaxillary orthognathic surgery is important for maxillofacial surgeons and anesthesiologists. The aim of this study was to determine the amount of blood loss during various types of orthognathic surgery. Materials & Methods: A total of 92 patients were selected and were separated into two groups of monomaxillary & bimaxillary. All the surgeries were performed in Ghaem Hospital of Mashhad University of Medical Sciences under anesthesia with deliberate hypotension. Blood pressure during surgery was maintained under 100 mm/hg. Surgical blood losses was measured by the amount of blood in the surgical suction unit and counting the number of gauze pads saturated with blood by the anesthesiologiste and at the end of surgery was recorded. In the end, the amount of blood loss was determined separately according to the type of surgery & was statistically analyzed. Results: The study sample consisted of 92 subjects with a mean age of 23.6±3.64 years and all of the subjects completed the study. The average surgical blood loss was 351.63 ml. Mann-Whitney Test showed that the amount of blood loss in class II was significientlya higher than class III (monomaxillary P=0.040 and bimaxillary P=0.008). Blood loss in monoaxillary surgery was significiently less than bimaxillary surgery (P<0.001). Conclusion: According to the present study, the amount of bleeding among different types of orthognathic surgeries is different depending on type & number of surgery and these factors are important in estimating the amount of blood loss and peredicting the necessary actions in order to replace the lost blood volume