儿童扁桃体腺样体日间手术术后出血的防范措施

Prevention measures of postoperative hemorrhage in children day surgery of tonsils and adenoids

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(χ^(2)=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(χ^(2)=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(χ^(2)=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。

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(χ^(2)=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(χ^(2)=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(χ^(2)=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.