Analysis of the causes of postoperative delayed hemorrhage of low temperature lasma tonsillectomy in children
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摘要: 目的: 探讨低温等离子手术方式行儿童扁桃体切除术后迟发性出血的原因。方法: 回顾性分析2~14岁行低温等离子扁桃体切除手术与传统扁桃体切除手术术后出血时间及出血率的差异性。等离子组患儿2012-03-2013-08期间行低温等离子扁桃体切除术,传统组患儿于2005-03-2006-08期间行冷器械扁桃体切除术。结果: 低温等离子手术方式组1000例,术后出血19例,出血率为1.9%。其中原发性出血4例,原发性出血率为0.4%,出血时间均在手术后8 h内。迟发性出血15例,迟发性出血率为1.5%,出血时间在2~13 d,平均7.5 d。15例迟发性出血患儿中,存在感染因素者9例,术后进食不当者6例。进食不当者中在出血前有4例患儿有进食水果及坚硬食物,2例患儿因进食多少导致体重减轻。传统手术方式组患儿860例,术后出血29例,出血率为3.37%,其中原发性出血26例,原发性出血率为3.02%。术后迟发性出血3例,迟发性出血率为0.35%,出血时间在2~6 d,平均4 d。结论: 儿童扁桃体切除术更适宜选择低温等离子的手术方式。其术后迟发性出血可能与术后感染,术后感染引发的刺激性干咳,饮食不当,主刀医师手术技术的差异,手术中止血的方式不同,患儿术后恢复期的护理,患儿及家长的对医嘱的依从性等因素相关。Abstract: Objective: Probe into the causes of postoperative delayed hemorrhage of low temperature plasma tonsillectomy in children.Method: The methods of retrospective analysis the difference of postoperative bleeding time and bleeding rate between tonsillectomy by the low temperature plasma and the traditional cold surgical devices in 2-14 years old children. Plasma group contained the tonsillectomy by low temperature plasma between the March in 2012 to the August in 2013. Traditional group contained the tonsillectomy by traditional cold surgical devices between the March in 2005 to the August in 2006.Result: In the 1 000 cases of plasma group, 19 cases occurred postoperative hemorrhage, the hemorrhage rate was 1.9%. Four cases occurred postoperative primary hemorrhage in 8 hours after operation, the postoperative primary hemorrhage rate was 0.4%. Fifteen cases occurred postoperative delayed hemorrhage,the delayed hemorrhage rate was 1.50%, the bleeding time was 2-13 days after operation, the average number was 7.5 days. Nine cases had wound infection and 6 cases had eaten some food improperly in these 15 cases. And in these eaten improperly cases, 4 children had eaten fruit and hard food, 2 children had eaten a little food who lost their weight. In 860 cases of the traditional group, 29 cases occurred postoperative hemorrhage, the hemorrhage rate was 3.37%. 26 cases occurred postoperative primary hemorrhage in 8 hours after operation, the postoperative primary hemorrhage rate was 3.02%. Three cases occurred postoperative delayed hemorrhage, the delayed hemorrhage rate was 0.35%, the bleeding time was 2-6 days, the average number was 4 days.Conclusion: It is preferable for chileren to having low temperature plasma tonsillectomy. The causes of postoperative delayed hemorrhage of low temperature plasma tonsillectomy in children are probably related to the postoperative infection, the differences of operation skills, the method of stop bleeding, eating the wrong foods, irritating cough, improper nursing and so on.
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