严格控制性降压对正颌手术术中出血量和术后肾功能的影响

doi:10.19438/j.cjoms.2026.02.009

摘要/Abstract

摘要： 目的: 评估严格控制性降压（平均动脉压≤55 mmHg）对正颌手术术中出血量及术后肾功能的影响。方法: 选择2024年5月—2025年3月于上海交通大学医学院附属第九人民医院行正颌手术的患者117例,根据术中血压管理策略分为严格控制性降压组（S组,MAP≤55 mmHg）与常规管理组（C组,MAP>55 mmHg）。比较两组术中失血量、术后急性肾损伤发生率等主要指标,以及术后血红蛋白、红细胞压积、手术时长等次要指标。结果: S组术中失血量显著低于 C组（P<0.001）,两组术后肌酐、Δ肌酐（术后与术前肌酐差值）及肌酐变异率无显著差异（P>0.05）;S组术后血红蛋白、红细胞压积显著高于C组（P<0.05）,降压时间显著长于C组（P<0.001）;术中尿量、手术时间、异体输血率、术后不良事件发生率及住院时间两组无显著差异（P>0.05）。结论: 正颌手术中实施严格控制性降压（MAP≤55 mmHg）可有效减少术中失血,且不增加术后肾功能损伤及不良事件风险,安全性良好。

关键词: 正颌手术, 控制性降压, 术后失血量, 急性肾损伤, 术后并发症

Abstract: PURPOSE: To evaluate the effect of strict controlled hypotension (mean arterial pressure≤55 mmHg) on intraoperative blood loss and postoperative renal function in orthognathic surgery. METHODS: A total of 117 patients who underwent orthognathic surgery in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from May 2024 to March 2025 were selected and divided into the strict controlled hypotension group (group S, MAP≤55 mmHg) and the conventional management group (group C, MAP>55 mmHg) according to the intraoperative blood pressure management strategy. The primary indicators such as intraoperative blood loss and postoperative incidence of acute kidney injury, as well as the secondary indicators such as postoperative hemoglobin, hematocrit and operation duration, were compared between the two groups. RESULTS: The intraoperative blood loss in group S was significantly lower than that in group C (P<0.001). There were no significant differences in postoperative creatinine, Δ creatinine (the difference between postoperative and preoperative creatinine) and creatinine variation rate between the two groups (P>0.05). The postoperative hemoglobin and hematocrit in group S were significantly higher than those in group C (P<0.05), and the hypotension duration in group S was significantly longer than that in group C (P<0.001). There were no significant differences in intraoperative urine output, operation time, allogeneic blood transfusion rate, postoperative adverse event rate and length of hospital stay between the two groups (P>0.05). CONCLUSIONS: The implementation of strict controlled hypotension (MAP≤55 mmHg) in orthognathic surgery can effectively reduce intraoperative blood loss without increasing the risk of postoperative renal function injury and adverse events, and has good safety.

Key words: Orthognathic surgery, Controlled hypotension, Postoperative blood loss, Acute kidney injury, Postoperative complications

中图分类号:

R780.05

徐蕴馨, 刘华, 吕翔. 严格控制性降压对正颌手术术中出血量和术后肾功能的影响[J]. 中国口腔颌面外科杂志, 2026, 24(2): 150-154.

Xu Yunxin, Liu Hua, Lyu Xiang. Impact of strict controlled hypotension on intraoperative hemorrhage and postoperative renal function in orthognathic surgery[J]. China J Oral Maxillofac Surg, 2026, 24(2): 150-154.

参考文献

[1] Lin S, McKenna SJ, Yao CF, et al. Effects of hypotensive anesthesia on reducing intraoperative blood loss, duration of operation, and quality of surgical field during orthognathic surgery: a systematic review and meta-analysis of randomized controlled trials[J]. J Oral Maxillofac Surg, 2017, 75(1): 73-86.
[2] Jeong J, Portnof JE, Kalayeh M, et al.Hypotensive anesthesia: comparing the effects of different drug combinations on mean arterial pressure, estimated blood loss, and surgery time in orthognathic surgery[J]. J Craniomaxillofac Surg, 2016, 44(7): 854-858.
[3] Samman N, Cheung LK, Tong AC, et al.Blood loss and transfusion requirements in orthognathic surgery[J]. J Oral Maxillofac Surg, 1996, 54(1): 21-24.
[4] Zaroni FM, Cavalcante RC, João da Costa D, et al. Complications associated with orthognathic surgery: a retrospective study of 485 cases[J]. J Craniomaxillofac Surg, 2019, 47(12): 1855-1860.
[5] Dauterman L, Khan N, Tebbe C, et al.Efficacy and safety of intraoperative controlled hypotension: a systematic review and meta-analysis of randomised trials[J]. Br J Anaesth, 2024, 133(5): 940-954.
[6] Wu X, Jiang Z, Ying J, et al.Optimal blood pressure decreases acute kidney injury after gastrointestinal surgery in elderly hypertensive patients: a randomized study: optimal blood pressure reduces acute kidney injury[J]. J Clin Anesth, 2017, 43: 77-83.
[7] Toivonen J, Kaukinen S, Oikkonen M, et al.Effects of deliberate hypotension induced by labetalol on renal function[J]. Eur J Anaesthesiol, 1991, 8(1): 13-20.
[8] Walsh M, Devereaux PJ, Garg AX, et al.Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension[J]. Anesthesiology, 2013, 119(3): 507-515.
[9] Wijnberge M, Schenk J, Bulle E, et al. Association of intraoperative hypotension with postoperative morbidity and mortality: systematic review and meta-analysis[J]. BJS Open, 2021, 5(1): zraa018.
[10] Ma H, Ahrens E, Wachtendorf LJ, et al.Intraoperative use of phenylephrine versus ephedrine and postoperative delirium: a multicenter retrospective cohort study[J]. Anesthesiology, 2024, 140(4): 657-667.
[11] Stevens PE, Levin A.Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving Global Outcomes 2012 clinical practice guideline[J]. Ann Intern Med, 2013, 158(11): 825-830.
[12] Schaberg SJ, Kelly JF, Terry BC, et al.Blood loss and hypotensive anesthesia in orofacial corrective surgery[J]. J Oral Surg, 1976, 34(2): 147-156.
[13] Prasant MC, Kar S, Rastogi S, et al.Comparative study of blood loss, quality of surgical field and duration of surgery in maxillofacial cases with and without hypotensive anesthesia[J]. J Int Oral Health, 2014, 6(6): 18-21.
[14] Sun LY, Wijeysundera DN, Tait GA, et al.Association of intraoperative hypotension with acute kidney injury after elective noncardiac surgery[J]. Anesthesiology, 2015, 123(3): 515-523.
[15] Mathis MR, Naik BI, Freundlich RE, et al.Preoperative risk and the association between hypotension and postoperative acute kidney injury[J]. Anesthesiology, 2020, 132(3): 461-475.
[16] Penev Y, Ruppert MM, Bilgili A, et al.Intraoperative hypotension and postoperative acute kidney injury: a systematic review[J]. Am J Surg, 2024, 232: 45-53.
[17] Evans RG, Ince C, Joles JA, et al.Haemodynamic influences on kidney oxygenation: clinical implications of integrative physiology[J]. Clin Exp Pharmacol Physiol, 2013, 40(2): 106-122.
[18] Just A.Mechanisms of renal blood flow autoregulation: dynamics and contributions[J]. Am J Physiol Regul Integr Comp Physiol, 2007, 292(1): R1-17.
[19] Kim JE, Lee JS, Kim MK, et al.Nicardipine infusion for hypotensive anesthesia during orthognathic surgery has protective effect on renal function[J]. J Oral Maxillofac Surg, 2014, 72(1): 41-46.
[20] Goto F, Otani E, Kato S, et al.Prostaglandin E1 as a hypotensive drug during general anaesthesia[J]. Anaesthesia, 1982, 37(5): 530-535.
[21] Thompson GE, Miller RD, Stevens WC, et al.Hypotensive anesthesia for total hip arthroplasty: a study of blood loss and organ function (brain, heart, liver, and kidney)[J]. Anesthesiology, 1978, 48(2): 91-96.
[22] Choi YJ, Kim SO, Sim JH, et al.Postoperative anemia is associated with acute kidney injury in patients undergoing total hip replacement arthroplasty: a retrospective study[J]. Anesth Analg, 2016, 122(6): 1923-1928.
[23] Sakhariya SV, Waknis PP, Setiya S, et al.Effect of induced hypotensive anesthesia and normotensive anesthesia on intraoperative blood loss during orthognathic surgery: a systematic review[J]. J Maxillofac Oral Surg, 2024, 23(5): 1127-1137.
[24] Golparvar M, Naddafnia H, Saghaei M.Evaluating the relationship between arterial blood pressure changes and indices of pulse oximetric plethysmography[J]. Anesth Analg, 2002, 95(6): 1686-1690.