Prevention measures of postoperative hemorrhage in children day surgery of tonsils and adenoids
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摘要: 目的 探讨儿童扁桃体腺样体日间手术的防范措施在减少术后出血中的效果，明确其安全性和可行性。方法 回顾性分析2021年2月至4月上海市儿童医院收治的649例因扁桃体腺样体肥大引起阻塞性睡眠呼吸暂停(OSA)行日间手术的患儿资料。根据是否采取防范措施分为观察组和对照组，比较2组患儿的术后出血率、出血时间和出血因素。结果 观察组术后出血4例(1.22%)，对照组12例(3.74%)，观察组术后出血率低于对照组(χ2=4.28，P=0.039)；观察组术后出血在第(8.25±2.75)天，对照组在第(7.42±1.98)天，2组术后出血时间的差异无统计学意义(χ2=2.601，P=0.321)；观察组术后出血病例中无术后感染患儿，对照组术后感染7例(58.3%)，2组差异有统计学意义(χ2=7.658，P=0.036)。结论 针对扁桃体腺样体日间手术患儿，在入院评估、预防感染、术后观察和宣教等方面采取相应防范措施，可以有效降低术后并发症的发生率，改善日间手术治疗效果。Abstract: Objective To investigate the effect of preventive measures in reducing postoperative bleeding, which is made for children day surgery on tonsils and adenoids in our hospital, and to clarify its safety and feasibility.Methods A retrospective analysis of 649 patients with children day surgery due to obstructive sleep apnea(OSA) caused by adenoid hypertrophy of tonsil was conducted. All of the patients were admitted to Shanghai Children's Hospital from February 2021 to April 2021. According to whether preventive measures were taken or not, they were divided into the control group and the observation group. The postoperative bleeding rate, bleeding time, and bleeding-related factors of the two groups were compared.Results There were 4 cases(1.22%) in the observation group and 12 cases(3.74%) in the control group, the postoperative bleeding rate of the observation group was lower than that of the control group(χ2=4.28, P=0.039). The postoperative bleeding in the observation group occurred(8.25±2.75) days after surgery while the control group(7.42±1.98) days, which shows no significant difference in postoperative bleeding time between the two groups(χ2=2.601, P=0.321). There was no case of postoperative infection in the observation group while 7 cases(58.3%) in the control group(χ2=7.658, P=0.036).Conclusion For children with day surgery of tonsils and adenoids, appropriate optimization measures can be taken for hospital admission evaluation, infection prevention, postoperative observation, publicity and education, which can effectively reduce the incidence of postoperative complications and improve the treatment effect of day surgery.
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Key words:
- child /
- tonsillectomy /
- adenoidectomy /
- sleep apnea, obstructive /
- day surgery /
- postoperative hemorrhage
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表 1 观察组和对照组性别和年龄比较
例 组别 例数 性别 年龄 男 女 0~3岁 4~6岁 7~9岁 ≥10岁 观察组 328 201 127 1 152 121 54 对照组 321 197 124 0 174 103 44 χ2 0.008 4.802 P 0.931 0.143 
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[1] 姜岚, 韩富根, 许莹, 等. OSAS患儿经低温等离子射频扁桃体部分切除术治疗的疗效评价[J]. 临床研究, 2021, 29(2): 41-42. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYN202102020.htm
[2] 汪普, 李勇. 鼻内镜下低温等离子刀扁桃体部分切除术联合腺样体切除术治疗儿童OSAHS的疗效分析[J]. 中国中西医结合耳鼻咽喉科杂志, 2015, 23(4): 287-290. https://www.cnki.com.cn/Article/CJFDTOTAL-XYJH201504014.htm
[3] 陶佳, 陈彦球, 孙昌志, 等. 儿童扁桃体腺样体切除日间手术模式探讨[J]. 中国眼耳鼻喉科杂志, 2020, 20(5): 375-377, 381. https://www.cnki.com.cn/Article/CJFDTOTAL-YRBH202005008.htm
[4] 儿童扁桃体腺样体低温等离子射频消融术规范化治疗临床实践指南[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(3): 193-199.
[5] 杨丽, 赵蓉. 上海市日间手术管理的标准化实践及思考[J]. 华西医学, 2019, 34(2): 179-183. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYX201902015.htm
[6] 李旭征, 张淑香. 低温等离子刀与传统剥离法在儿童扁桃体和腺样体切除术的对比研究[J]. 医学研究生学报, 2013, 26(8): 890-891. https://www.cnki.com.cn/Article/CJFDTOTAL-JLYB201308033.htm
[7] 毛志勇, 马静, 周丽娟, 等. 雾化吸入预防小儿扁桃体腺样体术后出血的疗效观察[J]. 中国医学文摘(耳鼻咽喉科学), 2017, 32(6): 358-360. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYEB201706023.htm
[8] Ahmad MU, Wardak AN, Hampton T, et al. Coblation versus cold dissection in paediatric tonsillectomy: a systematic review and meta-analysis[J]. J Laryngol Otol, 2020, 134(3): 197-204. doi: 10.1017/S0022215120000377
[9] Blanchford H, Lowe D. Cold versus hot tonsillectomy: state of the art and recommendations[J]. ORL J Otorhinolaryngol Relat Spec, 2013, 75(3): 136-141. doi: 10.1159/000342315
[10] Lee JS, Lee YC, Kim SW, et al. Changes in the quality of life of patients with laryngopharyngeal reflux after treatment[J]. J Voice, 2014, 28(4): 487-491. doi: 10.1016/j.jvoice.2013.12.015
[11] 李伟, 苏成, 王从军, 等. 小儿外科日间手术在综合医院应用模式的可行性研究[J]. 中华小儿外科杂志, 2020, 41(8): 710-715.
[12] de Luca U, Mangia G, Tesoro S, et al. Guidelines on pediatric day surgery of the Italian Societies of Pediatric Surgery(SICP)and Pediatric Anesthesiology(SARNePI)[J]. Ital J Pediatr, 2018, 44(1): 35. doi: 10.1186/s13052-018-0473-1
[13] 胡亚娟. 低温等离子射频消融治疗儿童OSAHS的临床观察[J]. 中国中西医结合耳鼻咽喉科杂志, 2015, 23(4): 285-286. https://www.cnki.com.cn/Article/CJFDTOTAL-XYJH201504013.htm
[14] Shakeel M, Trinidade A, Al-Adhami A, et al. Coblation adenotonsillectomy in children[J]. J Coll Physicians Surg Pak, 2012, 22(9): 579-581.
[15] Kim JW, Mun SJ, Lee WH, et al. Post-tonsillectomy hemorrhage in children: a single surgeon's experience with coblation compared to diathermy[J]. Eur Arch Otorhinolaryngol, 2013, 270(1): 339-344. doi: 10.1007/s00405-012-2098-0
[16] Bartier S, Gharzouli I, Kiblut N, et al. Tonsillectomy in children and in adults: changes in practice following the opening of a day-surgery unit with dedicated operating room[J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2018, 135(5): 301-305. doi: 10.1016/j.anorl.2018.05.003
[17] 李亮, 沈蓓. 儿童扁桃体腺样体低温等离子射频消融术后出血特点分析及应对策略[J]. 中国耳鼻咽喉头颈外科, 2016, 23(6): 309-312. https://www.cnki.com.cn/Article/CJFDTOTAL-EBYT201606001.htm
[18] 廖声静. 基于PDCA的口腔清洁管理在降低扁桃体术后出血发生率中的应用[J]. 长江大学学报(自科版), 2018, 15(16): 72-74. https://www.cnki.com.cn/Article/CJFDTOTAL-CJDL201816024.htm
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