儿童腺样体切除术后出血原因分析  

Analysis of the causes of immediate bleeding after pediatric adenoidectomy

作　　者：潘宏光[1] 李兰[1] 卢永田[2] 张德伦[1] 马翔宇[1] 冼志雄[1] 

机构地区：[1]深圳市儿童医院耳鼻咽喉科,518026 [2]深圳市第二人民医院耳鼻咽喉科

出　　处：《中华耳鼻咽喉头颈外科杂志》2011年第6期491-494,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：广东省深圳市科技计划项目（20092106）;深圳市医学重点专科（2005C03）

摘　　要：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0．5～4．0h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％，X^2=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2h内再次止血。Objective To evaluate the incidence of postoperative hemon＇ahage in children undergoing adenoideetomy , 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 hematoerit （ Hot ） were retrospectively analysed. The blood loss was estimated by the change of Het. 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% , X^2 =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.

关 键 词：腺样体切除术 手术后出血 儿童 

分 类 号：R766[医药卫生—耳鼻咽喉科]