术前血浆纤维蛋白原水平对扁桃体切除术后出血的预测作用

Predictive effect of preoperative plasma fibrinogen level on postoperative hemorrhage after tonsillectomy

目的评估术前血浆纤维蛋白原(FIB)水平是否能够预测扁桃体切除术后出血(PTH)。方法本研究共纳入2013~2018年行扁桃体切除手术的患者373例,按照术后是否出血分为出血组和对照组。收集患者术前血浆FIB和其他凝血指标、炎性指标数值,评估其在出血组和对照组患者中水平的差异,以及在术后出血中的预测作用。结果在所有入组患者中,42例(22.0%)出现了扁桃体切除术后显著出血。与对照组相比,出血组患者的红细胞沉降率、活化部分凝血活酶时间和FIB水平显著升高,差异均具有统计学意义(P=0.048、0.021、0.012)。在多因素Cox分析中,术前高水平FIB是PTH的相对危险因素(P=0.012,HR=1.40,95%CI:1.16~2.11)。当FIB临界值为3.6 g/L时,预测PTH的敏感度和特异度分别为73.2%和76.3%。此外,阳性预测值为46.5%,阴性预测值为91.0%,阳性似然比为3.09,阴性似然比为0.35,正确率为75.6%。结论术前高水平FIB水平是术后出血的独立预测因素,可作为扁桃体切除术前常规检查指标。

Objectives To assess whether preoperative plasma fibrinogen is able to predict severe posttonsillectomy haemorrhage(PTH).Methods A total of 373 patients undergoing tonsillectomy between 2013 and 2018 were included in the study.According to whether or not postoperative haemorrhage,all patients were divided into the bleeding group and the control group.Preoperative plasma fibrinogen levels and other coagulation and inflammatory markers were collected to assess differences in levels between the bleeding and control groups,as well as predictive effects on postoperative bleeding.Results In all enrolled patients,42(22.0%)patients experienced significant bleeding after tonsillectomy.Compared with the control group,the erythrocyte sedimentation level,activated partial thromboplastin time and fibrinogen levels were all significantly increased in the bleeding group,and the differences were statistically significant(P=0.048,0.021 and 0.012).In multivariate COX analysis,preoperative high-level fibrinogen was a risk factor for bleeding after tonsillectomy(P=0.012,HR=1.40,95%CI:1.16~2.11).When the fibrinogen threshold was 3.6 g/L,the sensitivity and specificity of bleeding after tonsillectomy were predicted to be 73.2%and 76.3%,respectively.In addition,the positive predictive value was 46.5%,the negative predictive value was 91.0%,the positive likelihood ratio was 3.09,the negative likelihood ratio was 0.35,and the correct rate was 75.6%.Conclusions Preoperative high fibrinogen level is an independent predictor of PTH and can be used as a routine predictor of tonsillectomy.