•论著・儿童腺样体切除术后出血原因分析潘宏光李兰卢永田张德伦马翔宇冼志雄【摘要】目的探讨儿童腺样体切除术后出血率及出血原因。方法回顾性分析2004年1月1日至2009年12月31日在深圳市儿童医院行腺样体切除或腺样体加扁桃体切除术患儿资料，统计患儿术后出血发生率及临床资料，并根据手术前肩红细胞斥积的变化估算失血员。结果2078例腺样体切除术患儿中右T0例术后出血，术后出血发生率是0.48%；术后0.5-4.0h后出现岀血，均为原发性出血;无术中界常出血和合并扁桃体切除术后出血的想儿。女密术后出血率(I.10%)A于男啟(0.21%,£=5.597,"<0.05)。血红蛋白的变化与红细胞压枳变化呈正相关(r=0.95,P<0.01),均能反应失血程度。血红贵白和红细胞压积变化与失血笊均呈止相关“值分别为0.79和0.85,P值均V0.01),失血盘与止血间隔时间呈正相关(r=0.66,P<0.05)o5例手术创面过深;2例鼻中隔或后鼻孔缘受损出血，凝血系统异常、母咽部慢性感染和术中止血不充分各1例。2例经后鼻孔填寒飞例再次全身麻醉下止血，术后无再次出血。结论腺样体术后出血的主要原因是手术操作不熟练和止血不充分，为预防失血过多,应在发现出血2h内再次止血。【关键词】腺样体切除术；手术后出血；儿童AnalysisofthecausesofimmediatebleedingafterpediatricadenoidectomyPANH(nig・guartg°,LILan、LUYong-tian,ZHANGDe-lun,MAXiang・yu、XIANZhi-xiong.eDepartmentofOtorhinolaryngologytShenzhenChildren9sHospital,Shenzhen518026,ChinaCorrespondingauthor:LILan.Email:drlil@J63.com[Abstract]ObjectiveToevaluatetheincidenceofpostoperativehemorrahageinchildrenundergoingadenoidectomy.andtodiscussitspossiblecauses・MethodsIncludedirithisstudywerechildrenwhounderuentadenoidand/ortonsilsurgeryatShenzhenChilidrcn"sHospitalbetweenJanuary2004andNovember2009・Thechangeofhemoglobin(Hb)andhematocrit(Het)wereretrospectivelyanalysed・ThebloodlosswasestimatedbythechangeofHet.ResultsTherewere2078casesthataccomplishedtheinclusioncriteriaintheperiodofstudy・Tenchildrenbled0・5一4.0hoursaftersurgery,withoutsuperfluoushemorrahageduringtheoperationandpost-tonsillectomy.Thisrepresentedanincidenceof0.48%ofimmediatepostoperativehaemorrhageamongthe2078proceduresanalyzed・Statisticaldiflcrenceswerefoundbetweenboys(0.21%)andgirls(1.10%,X=5・597,P<0.05).ThechangeofHbandHetwaspositivelycorrelated(r=0・95,P<0.01).thebloodlosswaspositivelycorrelatedwiththebleedingtime(r=0.66»P<0.05)・Thecausesofpostoperativehemorrhagewerecoagulationsystemdeficits,chronicnasopharyngitis,deficienthemostasisandimmoderateravage・Tocontrolthepostoperativehemorrhage,2postnasalpackingundertopicalanaesthesiaand8electrocauter)rundergeneralanaesthesiawereapplied・ConclusionsPooroperativetechniqueanddeficienthemostasisarethemajorcausesofprimaryhemorrahage・Promptoperationtocontrolthepost()[>erativebleedingshouldbedone2hoursafterbleedingundergeneralanesthesiainordertoavoidseverecomplications.[Keywords]Adenoidectomy；Postoperativehemorrhage;Child扁桃体、腺样体切除术是儿童耳鼻咽喉科最常见的手术，尽管每一位医生都尽可能地防止术后出DOI：10.3760/cmaj.issn.1673-0860.2011.06.011基金项目：广东省深圳市科技计划项目（20092106）；深圳市医学重点专科（2OO5CO3）作押廉位：518026深圳市儿肢氏院耳鼻咽喉科（潘宋光、李兰、张徳伦、q翔宇、冼吉擀）；深圳巾•第二人民医院耳鼻咽喉科（卢永田）通依作者：李兰，Email：drlil@l63.com血，但术后出血仍是扁桃体、腺样体切除术最主要的并发症。一•旦发生术后出血，给患儿、家长和医生带来巨大恐惧和忧虑，出血不但有损于患儿健康，严重时甚至危及生命。现冋顾性分析深圳市儿童医院近6年來行腺样体切除术患儿资料，总结腺样体切除术后出血的原因治疗方法及预防措施，报告如下。资料与方...