冷、热止血法与扁桃体切除术后疼痛关系的比较研究

Comparative study on the possible implications of‘warm'or‘cold'hemostatic procedures performed during tonsillectomy in post-operative local pain

目的观察电凝器喷凝止血法(热止血法)和压迫缝扎止血法(冷止血法)与扁桃体切除术后疼痛的相关性。方法行扁桃体摘除术的慢性扁桃体炎患者100例,分为2组,术中分别采用冷止血法和热止血法进行创面止血。分别记录术中出血量,术后每天观察进食情况以记录正常进食时间;采用McGill疼痛量表法,于术后第3天进行疼痛评分并作组问比较分析。结果热止血法组病例的术中平均出血量及术后进食时间分别为10.26±0.69ml和2.52±0.42d,而冷止血法组病例则分别为12.52±0.45ml及2.12±0.63d(P<0.05);比较术后疼痛持续时间,热止血法组病例有3个指标明显大干冷止血法组,仅1个指标明显短于后者(均P<0.05),其余指标组间差异无统计学意义(P>0.05)。结论热止血法手术操作较安全,术中出血量较少,但术后疼痛较明显。因而,应根据患者术中的具体情况灵活选择止血方法。

Objective To investigate the possible implications of＇warm＇or cold＇hemostatic procedures performed during tonsillectomy in post-operative local pain based on a clinical trial. Methods One hundred cases to be undergone tonsillectomy were divided into two groups, with 50 in each, and＇warm＇or＇cold＇ hemostatic procedures were performed to stop bleeding occurring in the wound during tonsillectomy for the cases in either group of cases. Then, the volume of bleeding occurred during the operation was recorded, the interval of time length begun to take in food as usual was determined following the surgery, and McGill pain scoring system was taken to evaluate the post-operative pain in a way of questionnaire at the third post-operative day for a comparative analysis between the two groups. Results The averaged volume of bleeding measured during the operation and the interval length of time begun to take in food as usual were 1 0.26＋0.69 ml and A compare study of evaluation on pain after tonsillectomy by warm and cold hemostasis 2.52＋0.42 d for the cases in the group with＇warm＇hemostatic procedures, while they were 12.52＋0.45 ml and 2.12＋0.63 d for those in the group with＇cold＇hemostatic procedures respectively, statistically with significance（P〈0.05）among them. When the scoring indicators to evaluate the persisting time length of post-operative pain in the wound were compared, three of them were significantly longer in the＇warm＇ hemostasis group than that in＇cold＇hemostasis group, with only one shorter in the former than in the latter9（P〈0.05）,but all the other indicators being of no significance statistically9（P〉0.05）. Conclusions The＇warm＇hemostatic procedures are safer to operate, with lesser volume of bleeding during the surgery, while with much significant post-operative pain in the local wound than the＇cold＇one. Therefore. it should be dependent upon the actual local situation of cases undergoing tonsillectomy to choice the most appropriate hemorrhage-stopping procedures for any individuals.