Analysis of the Effects of Local Injection of Epinephrine and Lidocaine on Postoperative Pain and Bleeding in Children Undergoing Tonsillectomy

Objective:To explore the effects of local injection of epinephrine and lidocaine on postoperative pain and bleeding in children undergoing tonsillectomy.Methods:Sixty-eight children who underwent a tonsillectomy in our hospital from March 2019 to October 2020 were selected.The children were randomly divided into two groups of 34 cases each.The observation group received local anesthetic injections of lidocaine and the control group received local anesthetic injections of epinephrine.The postoperative pain,operation time,blood pressure changes,and intraoperative blood loss of the two groups of children were observed and analyzed.Results:The postoperative pain,operation time,and intraoperative blood loss scores of the children in the observation group were 4.36±0.69,0.36±0.09,and 39.36±1.78 respectively,which were significantly better than those of the children in the control group(P<0.05)at 5.36±0.77,0.79±0.05,and 45.36±1.56,respectively.The systolic blood pressure and diastolic blood pressure of the observation group 3 minutes before surgery and 180 minutes after surgery were no different from those of the control group(P>0.05).Conclusion:Local injection of epinephrine and lidocaine effectively relieved postoperative pain and reduced bleeding in children undergoing tonsillectomy as compared to epinephrine alone.

Effectiveness of Low-Temperature Plasma Adenoidectomy Combined with Bilateral Tonsillectomy in the Treatment of Snoring in Children and Its Effect on Sleep Quality

Objective:To evaluate the therapeutic effect of low-temperature plasma adenoidectomy(abbreviation:adenoid low-temperature plasma excision)coupled with tonsillectomy(bilateral)on snoring in children.Methods:Seventy-six cases of snoring children treated in the hospital between November 2020 and November 2023 were selected.38 cases of children in Group A agreed to surgery and were admitted to the hospital for surgical treatment and were treated with adenoid cryo-plasma excision combined with tonsillectomy(bilaterally),and 38 cases of children in Group B did not agree to outpatient conservative treatment for surgery,and the results of the treatment were compared.Results:Before treatment,there was no difference between the ventilation function indexes,sleep quality scores,and quality of life scores of the two groups compared with each other(P>0.05).After treatment,the ventilation function indexes of Group A were better than Group B,and the sleep quality score and quality of life score were higher than that of Group B.The total effective rate of Group A was higher than that of Group B(P<0.05).Conclusion:Adenoid cryo-plasma excision combined with tonsillectomy(bilateral)can improve the quality of life,ventilation function,and sleep quality of children with snoring,and can enhance the efficacy.

Epstein-Barr virus is related with 5-aminosalicylic acid, tonsillectomy, and CD19^+ cells in Crohn's disease

AIM: To study anti-Epstein-Barr virus(EBV) Ig G antibodies in Crohn′s disease in relation to treatment, immune cells, and prior tonsillectomy/appendectomy.METHODS: This study included 36 CD patients and 36 healthy individuals(controls), and evaluated different clinical scenarios(new patient, remission and active disease), previous mucosa-associated lymphoid tissue removal(tonsillectomy and appendectomy) and therapeutic regimens(5-aminosalicylic acid, azathioprine, anti-tumor necrosis factor, antibiotics, and corticosteroids). T and B cells subsets in peripheral blood were analyzed by flow cytometry(markers included: CD45, CD4, CD8, CD3, CD19, CD56, CD2, CD3, TCRαβ and TCRγδ) to relate with the levels of anti-EBV Ig G antibodies, determined by enzyme-linked immunosorbent assay.RESULTS: The lowest anti-EBV Ig G levels were observed in the group of patients that were not in a specific treatment(95.4 ± 53.9 U/m L vs 131.5 ± 46.2 U/m L, P = 0.038). The patients that were treated with 5-aminosalicylic acid showed the highest anti-EBV Ig G values(144.3 U/m L vs 102.6 U/m L, P = 0.045). CD19+ cells had the largest decrease in the group of CD patients that received treatment(138.6 vs 223.9; P = 0.022). The analysis of anti-EBV Ig G with respect to the presence or absence of tonsillectomy showed the highest values in the tonsillectomy group of CD patients(169.2 ± 20.7 U/m L vs 106.1 ± 50.3 U/m L, P = 0.002). However, in the group of healthy controls, no differences were seen between those who had been tonsillectomized and subjects who had not been operated on(134.0 ± 52.5 U/m L vs 127.7 ± 48.1 U/m L, P = 0.523).CONCLUSION: High anti-EBV Ig G levels in CD are associated with 5-aminosalicylic acid treatment, tonsillectomy, and decrease of CD19+ cells.

Primary and secondary postoperative hemorrhage in pediatric tonsillectomy

Tonsillectomy is the most common procedure for treatment of pediatric recurrent acute tonsillitis and tonsillar enlargement that contributes to obstructive sleep apnea hypopnea syndrome.Postoperative hemorrhage of tonsillectomy is a lifethreatening complication.AIM To identify the risk factors that may contribute to primary and secondary postoperative hemorrhage in pediatric tonsillectomy.METHODS The clinical data from 5015 children,3443 males and 1572 females,aged 1.92-17.08 years,with recurrent tonsillitis and/or tonsil hypertrophy who underwent tonsillectomy in our hospital from January 2009 to December 2018 were retrospectively collected.The variables including sex,age,time of onset,diagnosis,method of tonsillectomy,experience of surgeon,time when the surgery started and monthly average air temperature were abstracted.The patients with postoperative hemorrhage were classied into two groups,the primary bleeding group and the secondary bleeding group,and their characteristics were compared with those of the nonbleeding group separately.Statistical analysis was performed by chi-square test with SPSS 20.RESULTS Ninety-two patients had post-tonsillectomy hemorrhage,and the incidence rate of post-tonsillectomy hemorrhage was 1.83%.The mean age was 5.75 years.Cases of primary hemorrhage accounted for approximately 33.70%(31/92),and cases of secondary hemorrhage occurred in 66.30%(61/92).The rate of reoperation for bleeding was 0.92%,and the rate of rehospitalization for bleeding was 0.88%in all patients.Multiple hemostasis surgery was performed in 6.52%(3/46)of patients.The method of tonsillectomy(coblation tonsillectomy)and experience of the surgeon(junior surgeon with less than 5 years of experience)were significantly associated with primary hemorrhage(χ^(2)=5.830,P=0.016,χ^(2)=6.621,P=0.010,respectively).Age(over 6 years old)and time of onset(more than a 1-year history)were significantly associated with secondary hemorrhage(χ^(2)=15.242,P=0.000,χ^(2)=4.293,P=0.038,respectively).There was no signicant difference in sex,diagnosis,time when the surgery started or monthly average air temperature.There was a signicant difference in the intervention measures between the primary bleeding group and the secondary bleeding group(χ^(2)=10.947,P=0.001).The lower pole and middle portion were the common bleeding sites,followed by the upper pole and palatoglossal arch.CONCLUSION The incidence rate of post-tonsillectomy hemorrhage is low.Coblation tonsillectomy and less than 5 years’experience of surgeon contribute to the tendency for primary hemorrhage.Age and time of onset are responsible for secondary hemorrhage.

Comparison of Coblation Tonsillectomy vs Dissection Tonsillectomy

Background: Tonsillectomy is one of the most commonly performed surgical operations in the recent years. It is mainly done for chronic tonsillitis and obstructive symptoms. Aims & Objectives: To compare the operating time, intraoperative blood loss, postoperative pain, time needed to return to normal diet and activity in coblation and dissection tonsillectomy. Methods: This is a prospective study done at Pushpagiri Medical College for a period of one and a half years from March 2015 to September 2016. Out of the 50 patients, 25 underwent coblation tonsillectomy and 25 underwent conventional dissection tonsillectomy. Method of surgery depended on patients’ or parents’ choice. Intra operative measures like operating time, blood loss and post-operative morbidity were measured and compared. Results: In this study, there was significant difference in intraoperative time in coblation tonsillectomy compared to cold dissection tonsillectomy (mean operative time—13.4 minutes for coblation and 20.4 minutes for cold dissection with p value less than 0.05). Intraoperative blood loss was significantly less for coblation (18.9 ml) compared to traditional (43.0 ml) with p value 0.002. Average postoperative pain score 6 hours after operation was 7.6 for coblation and 8.5 for cold dissection with a significant p value of 0.002. Average time taken to return to normal diet among coblation was 6.4 days and dissection was 7.0 days with p value of 0.078 which is not statistically significant. However, average time taken to return to normal activity among coblation was 6.3 days and dissection was 7.1 days with a significant p value of 0.024. Conclusion: Coblation tonsillectomy significantly reduces the operation time, intraoperative blood loss, immediate postoperative pain, and patient returns early to regular routine, but with a higher cost.

Coblation Intracapsular Tonsillectomy and Coblation Complete Tonsillectomy for Obstructive Sleep Apnea

Objective: Total tonsillectomy and intracapsular tonsillectomy are common procedures for the treatment of obstructive sleep apnea (OSA) in children. The objective of this study was to compare the effectiveness of coblation intracapsular tonsillectomy (ICT) and coblation complete tonsillectomy (CT) as treatments for OSA. Study design: A retrospective study of all the children ages 2 - 18 years with OSA who underwent coblation intracapsular tonsillectomy (ICT) or coblation complete tonsillectomy (CT) from January 2007 to August 2010 by the same surgeons at one institution. Methods: Data were retrieved from children’s charts and from telephone interviews with children’s parents, regarding pre and postoperative OSA-18 scores, postoperative pain, postoperative complications, use of analgesic drugs, and time to return to a solid food diet. Results: All 43 children who underwent ICT and 37 children who underwent CT suffered from OSA before surgery, and none did postoperatively. There were no minor complications in the ICT group, compared to 13.5% in the CT group (p = 0.01). According to parental report, 72% and 21% suffered a low level of postoperative pain, and 9% and 33% severe pain in the ICT and CT groups, respectively. For these respective groups, 49% and 73% needed analgesic drugs (p < 0.05);and 65% and 35% ate solid food during the first 3 days post surgery. Conclusions: Both ICT and CT were safe, with few complications;however recovery was faster in the ICT group, as demonstrated by less pain, and more rapid return to a solid food diet.

Post Tonsillectomy Bleeding among Children in a Tertiary Hospital in the Kingdom of Bahrain: Two Years Experience

Background: Palatine tonsils are part of the immune system located within the Waldeyer’s ring, they are prone to infections, hypertrophy or both. These conditions are known as tonsil diseases that usually require surgical removal through tonsillectomy. Tonsillectomy is one of the most common procedures done for children but it is challenged by the occurrence of complications, especially post tonsillectomy bleeding (PTB). In the current study, the incidence of post tonsillectomy bleeding in children younger than 14 years undergoing tonsillectomy in Salmaniya Medical Complex is evaluated and their demographic data and risk factors are assessed. Method: Pediatric patients who are younger than 14 years with postoperative tonsillectomy bleeding that were treated in Salmaniya Medical Complex between the period of January 2018 and December 2019 were retrospectively studied for risk factors. Results: A total of 1161 patients within the age range of 2 - 13 years old underwent tonsillectomy in Salmaniya Medical Complex from the period of January 2018 to December 2019. Twenty-eight pediatric patients had post-tonsillectomy bleeding (PTB) during the study period with an incidence of 2.4% of the total number of pediatric tonsillectomies done in our institute. The majority were male patients and the mean age was 6.2 years. The main indication of tonsillectomy for those with bleeding was recurrent tonsillitis. A second surgery was needed in 64.5% to control the bleeding. The size of the tonsil, the level of the surgeon and the season at which the tonsillectomy was done did not seem to have any effect on the incidence of post-tonsillectomy bleeding (PTB). Conclusion: The incidence of post tonsillectomy bleeding (PTB) in Salmaniya Medical Complex is 2.4%, which makes it a common complication for a common surgery irrelevant to any patient, surgeon or climate related factors.

Bipolar Radiofrequency (RF) in Pediatric Tonsillectomy: A Prospective Controlled Study

Background/Hypothesis: Tonsillectomy operation is one of the most frequently performed procedures in otolaryngology practice. Many tonsillectomy techniques have been used as a trial to improve post-operative results especially those related to pain and bleeding. We aimed to assess safety of bipolar radiofrequency tonsillectomy in pediatric patients, comparing its results with the classic cold steel technique. Study Design: Prospective controlled study. Methods: Two hundred cases were included in this study. They were placed into 2 groups which underwent tonsillectomy by 2 different techniques with comparison between the results of both groups. Results: Bipolar radiofrequency had a better result regarding time of the operation and intra-operative bleeding with similar results regarding post-operative pain and follow up. Conclusion: Bipolar radiofrequency is an effective and safe technique in total tonsillectomy with acceptable intra-operative and post-operative results regarding pain and bleeding and can be used in pediatric population with no major morbidities.

Measurement of Blood Loss during Adenotonsillectomy in Children and Factors Affecting It

This prospective study was done at the Southern Railway Headquarters Hospital, Ayanavaram, Chennai to measure the intraoperative blood loss during adenotonsillectomy and to assess the factors affecting it. Since blood volume in children is low, even a small loss will result in dreaded complications, so blood loss measurement in paediatric surgery is important. Adenotonsillectomy is the most common surgery performed in the field of otolaryngology, so blood loss measurement is essential in this surgery. In the study, 50 children who underwent adenotonsillectomy, by conventional dissection and snare method for tonsillectomy and curette method for adenoidectomy, were evaluated for operative blood loss. This study was conducted over a 1 year period, from June 2013 to June 2014. Both gravimetric method and blood volume studies were used to measure the operative blood loss. The estimated blood loss by gravimetric method was 94.35 ml, whereas the actual blood loss by blood volume studies was 90.57 ml and the average blood loss was 92.46 ml. The youngest child who was operated was 4 years old and the oldest child was 15 years old. The minimum blood loss was 40.30 ml and the maximum was 278.46 ml. In our series, operative blood loss was dependent on fibrosis of tonsil and the grade of the tonsil. There was no significant correlation between age and sex of the patient and the surgical skills.

Assessment of the Management of Post-Tonsillectomy Pain at the ENT-CFS Department of Ignace Deen National Hospital

Introduction: Tonsillectomy is described as one of the oldest surgical procedures according to the authors of the surgical treatise (Aulus Amida and Paul of Aegina in the 6th and 7th centuries) found in the Vatican library. The contraindication of codeine in children has changed the management of post tonsillectomy pain. The aim of this study was to assess the management of post tonsillectomy pain in our developing country context. Methods: This was a prospective, analytical study lasting 6 months (September 2019-February 2020), carried out in the ENT/CFS department of the Ignace Deen National Hospital. We included in this study all patients who underwent a tonsillectomy in the department during the study period and who agreed to participate in the survey. Results: 34 patients were included in our study, i.e. a frequency of 25% of surgical interventions. The mean age of our patients was 18.06 ± 12 years with extremes of 03 years and 45 years. Recurrent hypertrophic tonsillitis with sleep disturbances was the most frequent indication for surgery in our study, at 47.06% (n = 16). We performed an isolated tonsillectomy in 52.9% (n = 18) of cases. Analgesia was multimodal using the WHO Step I and II analgesics in 44.1% (n = 15) and 55.9% (n = 19), respectively. Pain control was satisfactory in all patients. Conclusion: The evaluation of post tonsillectomy pain is essential for optimal management. In this indication, multimodal analgesia, involving several levels I and II analgesics, provided satisfactory pain control.

Postoperative Outcomes in Coblation versus Electrocautery Tonsillectomies

Purpose: To investigate whether children undergoing a tonsillectomy or adenotonsillectomy (AT) with Coblation? will experience less postoperative pain and return to a normal diet and a regular activity level sooner compared to the same procedure using electrocautery dissection. This may manifest less school and work missed by the child and caregiver, respectively. Materials and Methods: Seventy-four children between the ages 2-13 years with either obstructive sleep apnea or chronic tonsillitis were recruited at a single tertiary-care center from January 2011 to November 2012 and underwent an AT via electrocautery or Coblation?. Caregivers were given a ten-point Wong-Baker FACES pain scale and questions inquiring the degree of oral intake, activity level, and impact on both the child and caregiver in regards to missing work or school on postoperative days (POD) 0, 1, 2, 3, 5, 7, and 14. Results: Children in the Coblation? arm required less pain medications (p 0.0049) on POD 0. Subsequent results were not significantly different for any other day. Age- and gendered-controlled multivariate analysis revealed a statistically significant difference in pain medications administered (p 0.0001) but not pain scores (p 0.2115) between the two techniques, although this difference in medications is likely related to the results observed on POD 0. There was no incidence of postoperative hemorrhage in either group. Conclusions: While there was less pain medication administered and slightly improved oral intake of liquids on POD 0 for children in the Coblation? arm, there was no difference in subsequent postoperative outcome or hemorrhage rates.

Analgesic Regimen and Readmission Following Tonsillectomy

Objective: To define the analgesic regimen given following tonsillectomy in a large ENT department and correlate this with readmission for secondary complications. Methods: We performed a retrospective case note review of patients undergoing tonsillectomy within a six month period. Demographic information and relevant case information was collected including operative details, discharge medication and readmission details. Results: 125 patients underwent tonsillectomy during the period. 17 different post-operative analgesic regimens were identified with the most common being a paracetamol and ibuprofen combination (26.4%). 13 patients (10.4%) were readmitted following discharge from hospital post-operatively, four (3.2%) for issues related to pain. There was no correlation between analgesic regimens and readmission. Conclusion: No apparent link between readmission and analgesic regimen was identified. The vast variation of analgesic regimens used has prompted development of a formal step-based analgesic protocol.

Examining the life-cycle of the Coblator II device:Increases in paediatric post-tonsillectomy haemorrhage after six years of use

All paediatric tonsillectomies were examined from 2012–2019 at a single tertiaryreferral institution,and all were performed by one of two paediatric otolaryngologists.One exclusively used the diathermy,the other exclusively used the Coblator II.Two Coblator units were purchased simultaneously in 2012 and not replaced.There was no significant difference in number of tonsillectomies performed(1298 via diathermy,1221 via Coblator),nor in postoperative day of bleed,patient age,indication for procedure,and no patient had an underlying coagulopathy.The most common indication for tonsillectomy in both groups was sleep-disordered breathing.There was no significant difference in postoperative haemorrhage rates between groups for the first six years of the study(0%-1.4%/year).Years 7 and 8 saw the Coblator group haemorrhage rate significantly increase(0%-0.6%diathermy group vs 2%-3%Coblator group),though still fell within accepted rate of postoperative haemorrhage.The devices were then replaced,and the differences in haemorrhage disappeared.There appears to be a significant increase in paediatric post-tonsillectomy haemorrhage when using a Coblator device greater than six years old.This may suggest a useful lifespan for the Coblator II device.

Nasopharyngeal Obstruction: A Rare Post Laser Assisted Tonsillectomy Complication

Tonsillectomy once was a most common ENT procedure, being referred in past as the “bread and butter of otorhinolaryngologists” though not so commonly performed these days. The usual complications of this procedure have been haemorrhage-primary/reactionary/secondary, infection, tonsillar bed structures injury, and even death. With the advent of newer technologies like lasers, microdebriders, coblators, harmonic scalpel, radiofrequency, newer complications also arise. This case report focuses on one such complication of laser assisted tonsillectomy, not much spoken of in books.

The Value of High Antistreptolysin O Titre as an Indicator of Tonsillectomy in Upper Egypt

Background: In this study, we aimed to evaluate the benefit of performing of tonsillectomy in patients with raised serum ASO titre only in absence or presence of group A beta heamolytic streptococci (GABHS) in throat swab. Materials and methods: In this prospective cohort study, 196 patients below the age of 14 were suffering from non-specific streptococcal infections, without fulfilling the clinical parameters used for the diagnosis of chronic tonsillitis 156 patients had a raised ASO titre above 200 iu/ml. Throat swab culture was performed in all patients. Results: The results showed that out of the 156 patients, 52 had positive throat swab for GABHS. All of the patients underwent tonsillectomy. Follow-up of the patients for one year after the operation, 88% of the first group with high ASO titre and positive throat swab showed improvement of symptoms;25% of the second group with high ASO titre and negative throat swab showed improvement of symptoms. Conclusion: Our study shows that isolation of GABHS from the patients tonsils by throat swab along with high ASO titre may be an indication of tonsillectomy in absence of any other indications.

A Rare Complication:Perioral Burn Related to Electrocautery Use during Adenotonsillectomy

Electrocautery is frequently used for incisions and bleeding control during adenotonsillectomy which is one of the most commonly performed pediatric surgical procedures. Although cases of perioral burn related to electrocautery use are rarely reported complications in literature, they account for a significant portion of malpractice lawsuits. The use of insulated surgical tools and lip protective equipment, careful surgery, and the frequent control of surgical equipment may decrease the number of this complication. This study examines whether a rarely reported complication related to perioral burn is indeed rarely seen or whether there are problems in reporting the real rates because it is evaluated to be a case of malpractice, and the protective factors that will prevent this problem. Consequently, it is underlined that this complication, which is more frequently seen than it is reported, should be a part of preoperative information process and the consent form.

Effect of ropivacaine combined with dexamethasone local infiltration on the pain level and inflammatory stress response after pediatric tonsillectomy

Objective:To study the effect of ropivacaine combined with dexamethasone local infiltration on the pain level and inflammatory stress response after pediatric tonsillectomy.Methods:A total of 84 children who received selective tonsillectomy in Mianyang Central Hospital between June 2014 and April 2017 were selected as the research subjects and divided into two groups by random number table method, combined group received ropivacaine combined with dexamethasone local infiltration, and control group accepted ropivacaine local infiltration anesthesia. Serum levels of pain mediators, inflammatory mediators and stress mediators were detected 6 h, 12 h and 24 h after surgery.Results: 6 h after surgery, serumβ-EP, SP, BK, TNF-α, MCP-1, IL-4, IL-10, F-Cor, NE, AT-II and GH levels were not significantly different between the two groups;12 h and 24 h after surgery, serumβ-EP, SP, BK levels of control group were significantly higher than those 6 h after surgery, serumβ-EP, SP, BK levels of combined group were not significantly different from those 6 h after surgery. Serum TNF-α, MCP-1, IL-4, IL-10, F-Cor, NE, AT-II and GH levels of two groups were significantly higher than those 6 h after surgery, and Serum TNF-α, MCP-1, IL-4, IL-10, F-Cor, NE, AT-II and GH levels of combined group were significantly lower than control group.Conclusion:Ropivacaine combined with dexamethasone local infiltration is with more durable and exact effect than ropivacaine local infiltration alone on relieving the pain and inflammatory stress response after pediatric tonsillectomy.

Safe surgical zone during TORS radical tonsillectomy:An anatomical and radiological study

Objective:Parapharyngeal space contains intricate vascular anatomy(external and internal carotid arteries)that might be inadvertently injured during the dissection in this plane.None of the bony landmarks can be used during the transoral robotic surgery(TORS)radical tonsillectomy as these landmarks lie lateral to the internal carotid artery(ICA)and external carotid artery(ECA)in transoral approach.Our study aims to identify the safe surgical limits during the dissection of parapharyneal space in TORS radical tonsillectomy and to correlate the same with radiological study.Material and methods:Fifteen cadavers(30 head and neck regions)and 50 CT-Angiogram of neck(100 head and neck regions)were included in the anatomical and radiological study respectively.The vertical midpoint of anterior tonsillar pillar(palatoglossus muscle)was taken as the reference point and all the measurements were done at the level of reference point both for anatomical and radiological study.Distance between tonsillar fossa and ECA,distance between tonsillar fossa and ICA,relation between ECA and styloglossus and relation between ICA and stylopharyngeus at reference level were studied.Results:The mean distance of ECA from the tonsillar fossa at the reference point was 18.2 mm in the anatomical study and 16.2 mm in the radiological study.The mean distance of ICA from the tonsillar fossa was 23.4 mm and 23.3 mm in the anatomical study and radiological study.There was no significant difference between the anatomical and radiological findings for both the mean distance between ECA and ICA to the tonsillar fossa(p value was 0.45 and 0.30 respectively).ECA was located posterolateral to styloglossus in 24 cases(80.0%)and 79 cases(79.0%)in the anatomical and radiological study respectively.ICA was found posterolateral to stylopharyngeus in 21 cases(70.0%)and 69 cases(69.0%)in the anatomical and radiological study respectively.Conclusion:The muscular plane between styloglossus and stylopharyngeus can be used as an envelope to locate the ECA and ICA that lie medial to these critical vascular structures during TORS.We propose to divide the parapharyngeal space into two compartments(anterior and posterior)based on the surgical perspective of inside-out anatomy.The anterior compartment houses styloglossus muscle with ECA posterolateral to it and the posterior compartment has stylopharyngeus and ICA posterolateral to it.

加速康复外科在低温等离子下扁桃体切除患者中的护理效果

目的探究加速康复外科在低温等离子下扁桃体切除患者中的护理效果。方法选取2021年1—12月于丰城市人民医院行低温等离子下扁桃体切除术的40例患者作为研究对象,以入院日期单双号为标准分为对照组与观察组,每组20例。对照组采用常规护理,观察组采用加速康复外科护理,比较两组术期相关指标、疼痛程度、临床症状消失时间、手术相关并发症。结果观察组术后正常进食时间、白膜形成时间、白膜脱落时间、住院时间均短于对照组,差异有统计学意义(P<0.05)。术后1、3、5、7d,观察组视觉模拟评分法(visual analogue scale,VAS)评分均低于对照组,差异有统计学意义(P<0.05)。观察组术后睡眠呼吸粗重、鼻翼煽动、流鼻涕、鼻塞症状消失时间均短于对照组,差异有统计学意义(P<0.05)。观察组手术相关并发症发生率为5.00%,低于对照组的30.00%,差异有统计学意义(P<0.05)。结论加速康复外科理念对低温等离子下扁桃体切除护理效果显著,能减轻患者术后疼痛,提高术后舒适度,缩短住院时间,值得临床推广应用。

腺样体联合扁桃体切除术对OSAHS患儿睡眠质量的影响

目的:探讨腺样体联合扁桃体切除术对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿睡眠质量的影响。方法:选取郑州儿童医院2021年1月至2022年7月收治的98例OSAHS患儿,随机分为对照组和观察组,各49例。对照组采用单纯腺样体切除术,观察组采用腺样体联合扁桃体切除术。比较两组患儿治疗后临床疗效、手术前后呼吸暂停通气指数(AHI)、阻塞性呼吸暂停指数(OAI)、最低血氧饱和度(LSaO_(2))水平变化、睡眠质量及OSAHS对生活质量的影响程度,并统计6个月内并发症情况。结果:治疗后观察组患儿临床总有效率高于对照组,差异具有统计学意义(P<0.05)。与术前比较,出院时两组患儿AHI及OAI水平均降低,且观察组患儿AHI及OAI水平均低于对照组,差异具有统计学意义(P<0.05);出院时两组患儿LSaO_(2)水平均明显高于术前,差异具有统计学意义(P<0.05),但组间LSaO_(2)水平比较,差异无统计学意义(P>0.05)。与术前比较,出院时两组患儿匹茨堡睡眠质量指数量表(PSQI)评分、Epworth嗜睡量表(ESS)评分及儿童OSAHS疾病特异性生活质量调查量表(OSA-18)评分均降低,且观察组患儿PSQI、ESS及OSA-18评分均低于对照组,差异具有统计学意义(P<0.05)。术后6个月内,观察组患儿并发症发生率低于对照组,差异具有统计学意义(P<0.05)。结论:腺样体联合扁桃体切除术可更有效地降低OSAHS患儿AHI、OAI水平,改善其睡眠、生活质量,降低术后扁桃体再度增生及扁桃体反复发炎风险,整体临床疗效优于单纯腺样体切除术,对于腺样体和扁桃体肥大的患儿,建议同时切除腺样体和扁桃体。