目的:评估在腺样体切除术中使用不同的止血材料以改善生活质量的效果,而对儿科健康的危害却可以忽略不计。
方法:是前瞻性的,case-series,随机化,控制,双盲研究。
方法:所有腺样体切除术均于2016年9月至2019年12月在三级转诊机构进行。
方法:519例患者分为5组。在全身麻醉下进行腺样体切除术,使用以下止血程序:肾上腺素,氨甲环酸,过氧化氢,赛洛唑啉,和生理盐水(作为对照组)。比较五组患者术中出血量,手术持续时间,需要更多的止血步骤,术后反应性和继发性出血,术后疼痛和口臭,和一年的结果。
结果:这四种方法有效减少了19.86%的失血,11.7%,30.95%,18.91%,分别,与对照组相比。手术时间缩短了27.65%,17.86%,48.11%,23.88%,分别。在过氧化氢组中,对其它止血步骤的需要最少。关于反应性出血,五组之间没有显着差异。继发性出血,一周的疼痛,一个月的疼痛,一个月的口臭,和一年的并发症。在另一边,五组中过氧化氢的口臭和第一天疼痛最少。此外,术中失血量和手术时间最少.
结论:过氧化氢是控制腺样体切除术中止血的最佳选择。它可以减少失血和手术持续时间,而不需要其他止血步骤。可提高患者的生活质量,且术后无明显并发症。首次将Xylometazoline作为腺样体切除术中的止血材料进行了研究,并获得了令人满意的结果。
OBJECTIVE: To evaluate the effect of different hemostatic materials used in adenoidectomy operations to improve the quality of life with the most negligible hazardous impact on pediatric health.
METHODS: a prospective, case-series, randomized, controlled, double-blinded study.
METHODS: All adenoidectomy surgeries were performed between September 2016 to December 2019 at tertiary referral institutions.
METHODS: 519 patients were included in five groups. Adenoidectomy was performed under general anesthesia, with the following hemostatic procedures: adrenaline, tranexamic acid, hydrogen peroxide,
xylometazoline, and saline (as a control group). The five groups were compared regarding the intraoperative blood loss, surgery duration, need for more hemostatic steps, postoperative reactionary and secondary bleedings, postoperative pain and halitosis, and one-year outcome.
RESULTS: The four procedures were effective in reducing the blood loss by 19.86%, 11.7%, 30.95%, and 18.91%, respectively, in comparison to the control group. The surgical duration was reduced by 27.65%, 17.86%, 48.11%, and 23.88%, respectively. The need for other hemostatic steps was the least in the hydrogen peroxide group. There was no significant difference between the five groups regarding reactionary bleeding, secondary bleeding, one-week pain, one-month pain, one-month halitosis, and one-year complications. On the other side, hydrogen peroxide had the least one-week halitosis and first-day pain among the five groups. Also, it had the least intraoperative blood loss and surgery duration.
CONCLUSIONS: Hydrogen peroxide showed to be the best choice to control hemostasis during an adenoidectomy. It can decrease blood loss and surgery duration with less need for other hemostatic steps. It can improve the patient\'s quality of life without significant postoperative complications.
Xylometazoline was studied for the first time as a hemostatic material during adenoidectomy with good satisfying results.