正颌手术的用药方案：对血流动力学和疼痛控制的比较效果。
Medication Regimens for Orthognathic Surgery: Comparative Effects on Hemodynamics and Pain Control.
文献信息
| PMID | 42779514 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Thomas Ren |
| 作者单位 | Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. |
| 期刊 | The Journal of craniofacial surgery |
| SCI 分区 | Q3 |
| IF | 1.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
背景： 加速康复外科方案已越来越多地应用于正颌手术，但标准化分阶段麻醉方案对围手术期血流动力学和疼痛控制的影响仍未完全明确。本研究评估了接受正颌手术患者的标准化诱导和苏醒方案。
方法： 对2019年至2025年间在一家三级学术中心接受Le Fort I截骨术的患者进行了回顾性队列研究。患者被分为4组：同时接受诱导和苏醒方案、仅接受诱导方案、仅接受苏醒方案以及常规麻醉管理。主要结局包括标准化围手术期时间点的平均动脉压（MAP）和心率。次要结局包括术后第0至2天的疼痛评分。一项亚分析评估了氨甲环酸（TXA）的独立效应。
结果： 本研究纳入171例患者：137例对照、12例仅诱导方案、18例仅苏醒方案和4例同时接受两种方案的患者。基线临床变量，包括阻塞性睡眠呼吸暂停、气道病史、性别、体重指数和美国麻醉医师学会（ASA）分级，在各队列间具有可比性（P>0.05）。苏醒时的MAP在各队列间存在显著差异，同时接受两种方案队列的值最低。与对照组相比，同时接受两种方案患者的术后第0天疼痛评分中位数和最大值也显著更低。在对照队列中，TXA与术中MAP显著降低相关。
结论： 基于苏醒的标准化麻醉方案与正颌手术后早期血流动力学控制改善和急性疼痛减轻相关。TXA可能独立降低术中MAP，但仍需要前瞻性研究来验证这些发现。
英文摘要
BACKGROUND: Enhanced recovery after surgery protocols have been increasingly applied to orthognathic surgery, but the effects of standardized phase-specific anesthetic regimens on perioperative hemodynamics and pain control remain incompletely characterized. This study evaluated standardized induction and emergence protocols in patients undergoing orthognathic surgery.
METHODS: A retrospective cohort study was performed of patients undergoing Le Fort I osteotomy at a single tertiary academic center between 2019 and 2025. Patients were stratified into 4 groups: both induction and emergence protocols, induction protocol only, emergence protocol only, and conventional anesthetic management. Primary outcomes included mean arterial pressure (MAP) and heart rate at standardized perioperative time points. Secondary outcomes included pain scores on postoperative days 0 through 2. A sub-analysis evaluated the isolated effect of tranexamic acid (TXA).
RESULTS: The study included 171 patients: 137 controls, 12 induction-only, 18 emergence-only, and 4 both-protocol patients. Baseline clinical variables, including obstructive sleep apnea, airway history, sex, body mass index, and American Society of Anesthesiologists (ASA) class, were comparable across cohorts (P>0.05). MAP upon awakening differed significantly across cohorts, with the lowest value in the both-protocol cohort. Median and maximum postoperative day 0 pain scores were also significantly lower in both-protocol patients compared with controls. In the control cohort, TXA was associated with significantly lower intraoperative MAP.
CONCLUSIONS: Standardized emergence-based anesthetic protocols were associated with improved early postoperative hemodynamic control and reduced acute pain after orthognathic surgery. TXA may independently reduce intraoperative MAP, although prospective studies are needed to validate these findings.