儿童扁桃体腺样体射频消融术围手术期抗生素应用必要性的探讨

The effect of antibiotic therapy on recovery after adenotonsillectomy in children

目的:通过前瞻性研究探讨儿童扁桃体腺样体射频消融术围手术期抗生素的临床应用价值。方法:收集上海市儿童医院耳鼻咽喉头颈外科2021年11月-2022年6月收治的117例扁桃体肥大伴有腺样体肥大的患儿,采用随机分组方式分为观察组(61例)和对照组(56例)。观察组术前术后不使用抗生素,均以盐水代替;对照组术前30 min及术后当日均静脉使用氨苄西林舒巴坦钠。采用SPSS?v.21.0进行统计学分析,采用χ^(2)检验评估观察组与对照组术后出血以及发热情况;采用两独立样本均数t检验评估观察组与对照组术后连续3 d疼痛评分、疼痛消失时间以及创面修复时间,采用线性相关分析评估年龄与术后疼痛的相关性。结果:观察组3例(4.9%),对照组2例(3.6%),两组比较差异无统计学意义(χ^(2)=0.129,P=0.719);观察组创面修复时间为(18.25±2.353) d,对照组为(18.05±2.711) d,两组相比差异无统计学意义(P=0.671);术后第1天,年龄和疼痛评分的Pearson相关系数为0.071,术后第2天为0.115,术后第3天为0.243,年龄和疼痛消失时间的Pearson相关系数为0.136,差异均无统计学意义(P>0.05)。两组术后体温比较,差异有统计学意义(χ^(2)=20.525,P<0.01)。围手术期抗生素的使用是预防术后发热的保护性因素(OR=0.167)。观察组第1~3天疼痛评分分别为6.52±1.963,5.87±2.093,5.02±2.149,对照组第1~3天分别为4.82±1.820,4.18±1.759,3.04±1.907,两组差异有统计学意义(P<0.01);观察组疼痛消失的时间为(7.36±2.483) d,对照组为(5.14±2.004) d,两组差异有统计学意义(P<0.01)。结论:儿童扁桃体腺样体射频消融术围手术期使用抗生素可有效减轻术后发热、咽喉部疼痛症状,缩短疼痛时间。

Objective: This prospective study was to evaluate the role of perioperative antibiotics use in children after adenotonsillectomy. Methods: A total of 117 children undergoing adenotonsillectomy admitted to the Department of Otolaryngology Head and Neck Surgery of Shanghai Children’s Hospital from November 2021 to June 2022 were collected and randomly divided into observation group(61 cases) and control group(56 cases). The observation group was not given antibiotics before and after operation, but was given saline instead. The control group received ampicillin sulbactam sodium intravenously 30 min before surgery and the day after surgery. SPSS?v. 21.0. was used for statistical analysis, and χ^(2) test was used to evaluate postoperative bleeding and fever between the observation group and the control group. Two independent sample mean T-test was used to evaluate the throat pain score consecutive 3 days after the surgery, the time to resume to normal diet and the wound healing time between the two groups. The correlation between age and postoperative pain was assessed by linear correlation analysis. Results: Three cases of hemorrhage in the observation group(4.9%) and 2 cases of hemorrhage in the control group(3.6%). There was no significant difference between the two groups(χ^(2) =0.129, P =0.719). The wound repair time was(18.25±2.353) d in the observation group and(18.05±2.711) d in the control group, and there was no significant difference between the two groups(P =0.671). The Pearson correlation coefficient between age and pain score was 0.071 on the first day after surgery, 0.115 on the second day and 0.243 on day third day. Pearson correlation coefficient between age and time of pain disappearance was 0.136, with no statistical significance(P>0.05). The difference of postoperative body temperature between the two groups was statistically significant(χ^(2)=20.525, P<0.01), perioperative antibiotic use was a protective factor for preventing postoperative fever(OR=0.167);The pain scores were 6.52±1.963, 5.87±2.093, 5.02±2.149 in the observation group and 4.82±1.820, 4.18±1.759, 3.04±1.907 in the control group on day 1 to 3 after surgery, respectively. The difference between the two groups was statistically significant(P<0.01);The time of pain disappearance was(7.36±2.483) days in the observation group and(5.14±2.004) days in the control group, and the difference between the two groups was statistically significant(P<0.01). Conclusion: Perioperative use of antibiotics in children with adenotonsillectomy can effectively reduce postoperative fever, throat pain symptoms and shorten the pain time.