腺样体和(或)扁桃体消融切除术患儿术后发生3度及以上出血的影响因素分析

Analysis of influencing factors of postoperative hemorrhage with degree 3 or above in children with adenoidectomy and/or tonsillectomy

目的探讨腺样体和扁桃体消融切除术患儿术后发生3度以上出血的影响因素。方法选取2018年1月至2023年12月首都儿科研究所附属儿童医院行腺样体和(或)扁桃体消融切除术患儿,根据术后是否发生3度及以上出血分为未出血组和出血组。采用倾向性得分匹配(prospensity score matching,PSM)1∶4的比例进行匹配,采用多因素logistic回归方程分析腺样体和(或)扁桃体消融切除患儿术后发生3度及以上出血的影响因素。结果共纳入患儿7805例,其中男5087例、女2718例,年龄1~18岁,平均(5.6±2.1)岁,发生3度及以上术后出血26例(3.3‰),原发性出血22例(84.6%),其中14例发生于术后6 h内;继发性出血4例(15.4%),均发生于术后5.5~9 d。PSM共成功匹配26对。多因素logistic回归分析结果显示,BMI越大(OR=18.266,95%CI:1.502~22.099,P=0.023)、手术部位为扁桃体伴或不伴腺样体切除(OR=42.540,95%CI:35.585~49.938,P<0.001)的患儿,术后发生3度及以上出血的风险越高。结论腺样体和(或)扁桃体消融切除术患儿术后3度及以上出血的发生率较低,主要发生于术后24 h内。BMI和手术部位是术后发生3度及以上出血的影响因素。

Objective To explore the influencing factors of postoperative hemorrhage with degree 3 or above in children with adenoidectomy and/or tonsillectomy.Methods Children who underwent adenoidectomy and/or tonsillectomy in Children’s Hospital,Capital Institute of Pediatrics from January 2018 to December 2023 were selected,and were divided into non-bleeding group and bleeding group according to whether postoperative hemorrhage with degree 3 or above occurred or not.The ratio of propensity score matching(PSM)was 1:4,and influencing factors of postoperative hemorrhage with degree 3 or above in children with adenoidectomy and/or tonsillectomy were analyzed by multivariate logistic regression equation.Results A total of 7805 children were included,there were 5087 males and 2718 females,aged from 1 to 18 years,with an average age of(5.6±2.1)years.There were 26 cases of postoperative hemorrhage with degree 3 or above,and the incidence rate was 3.3‰.There were 22 cases(84.6%)of primary bleeding,of which 14 cases occurred within 6 h after operation and four cases(15.4%)of secondary bleeding,all of which occurred at 5.5-9 d after operation.A total of 26 pairs were successfully matched by PSM.Multivariate logistic regression analysis results showed that children with higher BMI(OR=18.266,95%CI:1.502-22.099,P=0.023)and the surgical site involves tonsillectomy with or without adenoidectomy(OR=42.540,95%CI:35.585-49.938,P<0.001)had higher risks of postoperative hemorrhage with degree 3 or above.Conclusions The incidence of postoperative hemorrhage with degree 3 or above in children with adenoidectomy and/or tonsillectomy is low,and mainly occurred within 24 h after the operation.BMI and surgical site are the influencing factors of postoperative hemorrhage with degree 3 or above.