CAJ | 학술논문

目的探讨儿童腺样体切除术后出血率及出血原因.方法回顾性分析2004年1月1日至2009年12月31日在深圳市儿童医院行腺样体切除或腺样体加扁桃体切除术患儿资料,统计患儿术后出血发生率及临床资料,并根据手术前后红细胞压积的变化估算失血量.结果 2078例腺样体切除术患儿中有10例术后出血,术后出血发生率是0.48%;术后0.5～4.0 h后出现出血,均为原发性出血;无术中异常出血和合并扁桃体切除术后出血的患儿.女童术后出血率(1.10%)高于男童(0.21%,x2=5.597,P<0.05).血红蛋白的变化与红细胞压积变化呈正相关(r=0.95,P<0.01),均能反应失血程度.血红蛋白和红细胞压积变化与失血量均呈正相关(r值分别为0.79和0.85,P值均<0.01),失血量与止血间隔时间呈正相关(r=0.66,P<0.05).5例手术创面过深;2例鼻中隔或后鼻孔缘受损出血,凝血系统异常、鼻咽部慢性感染和术中止血不充分各1例.2例经后鼻孔填塞,8例再次全身麻醉下止血,术后无再次出血.结论腺样体术后出血的主要原因是手术操作不熟练和止血不充分,为预防失血过多,应在发现出血2 h内再次止血.
목적 탐토인동선양체절제술후출혈솔급출혈원인.방법 회고성분석2004년1월1일지2009년12월31일재심수시인동의원행선양체절제혹선양체가편도체절제술환인자료,통계환인술후출혈발생솔급림상자료,병근거수술전후홍세포압적적변화고산실혈량.결과 2078례선양체절제술환인중유10례술후출혈,술후출혈발생솔시0.48%;술후0.5～4.0 h후출현출혈,균위원발성출혈;무술중이상출혈화합병편도체절제술후출혈적환인.녀동술후출혈솔(1.10%)고우남동(0.21%,x2=5.597,P<0.05).혈홍단백적변화여홍세포압적변화정정상관(r=0.95,P<0.01),균능반응실혈정도.혈홍단백화홍세포압적변화여실혈량균정정상관(r치분별위0.79화0.85,P치균<0.01),실혈량여지혈간격시간정정상관(r=0.66,P<0.05).5례수술창면과심;2례비중격혹후비공연수손출혈,응혈계통이상、비인부만성감염화술중지혈불충분각1례.2례경후비공전새,8례재차전신마취하지혈,술후무재차출혈.결론 선양체술후출혈적주요원인시수술조작불숙련화지혈불충분,위예방실혈과다,응재발현출혈2 h내재차지혈.
Objective To evaluate the incidence of postoperative hemorrahage in children undergoing adenoidectomy , and to discuss its possible causes. Methods Included in this study were children who underwent adenoid and/or tonsil surgery at Shenzhen Chilidren's Hospital between January 2004 and November 2009. The change of hemoglobin ( Hb) and hematocrit ( Hct) were retrospectively analysed. The blood loss was estimated by the change of Hct. Results There were 2078 cases that accomplished the inclusion criteria in the period of study. Ten children bled 0. 5 - 4. 0 hours after surgery,without superfluous hemorrahage during the operation and post-tonsillectomy. This represented an incidence of 0.48% of immediate postoperative haemorrhage among the 2078 procedures analyzed. Statistical differences were found between boys (0.21%) and girls (1.10%, x2 =5.597, P<0.05). The change of Hb and Hct was positively correlated (r = 0. 95 , P < 0. 01) , the blood loss was positively correlated with the bleeding time ( r = 0. 66, P < 0. 05 ) . The causes of postoperative hemorrhage were coagulation system deficits, chronic nasopharyngitis, deficient hemostasis and immoderate ravage. To control the postoperative hemorrhage, 2 postnasal packing under topical anaesthesia and 8 electrocautery under general anaesthesia were applied. Conclusions Poor operative technique and deficient hemostasis are the major causes of primary hemorrahage. Prompt operation to control the postoperative bleeding should be done 2 hours after bleeding under general anesthesia in order to avoid severe complications.