目的 探讨扁桃体切除术后再出血的发生率, 并评价与术后再出血相关的风险因素. 方法 分析我院2003年至2013年692名住院行扁桃体切除术的患者. 其中发生术后出血者根据出血严重程度分三类:I:无创止血治疗后即可控制的极少量出血;II:需要局麻下止血的再出血;Ⅲ:需要全麻下止血的再出血. 采用logistic回归模型评价的风险因素指标包括:性别、年龄(成人和儿童)、扁桃体切除术术式、手术时间、结扎类型、术后抗生素使用时间等. 结果 692例患者中有80例发生术后出血,其中原发性和继发性出血分别占1.6%和10%.18例患者发生第三类再出血,再次手术的整体风险为2.6%,并且多于手术后5至6天高发,而且男性成年患者中发生率更高. 多因素logistic回归分析显示,成年患者和男性患者都是再出血发生的独立风险因素,也是第三类再出血发生的独立风险因素. 结论 男性患者和成年患者是再出血发生的独立风险因素,也是第三类再出血发生的独立风险因素.%Objective To investigate the rate of post-tonsillectomy hemorrhage (PTH) in a single institution and to evaluate the clinical risk factors for PTH. Methods We reviewed the records of 692 patients who underwent tonsillectomy (TE) in our hospital between 2003 and 2013. PTH grades were grouped into three categories according to the severity of the hemorrhagic episode:(Ⅰ) minimal hemorrhage that stopped after noninvasive treatment, (Ⅱ) hemorrhage requiring treatment with local anesthesia, and (Ⅲ) hemorrhage requiring reoperation under general anesthesia in the operating room. Clinical risk factors such as sex, age (adults vs. children), TE indication, operative time, ligature type, and duration of antibiotic administration for PTH were investigated. Results Among the 692 patients, 80 (11.6%) showed PTH, with primary and secondary hemorrhage accounting for 1.6% and 10.0%, respectively. A categoryⅢPTH was observed in 18 patients;thus, the overall risk of re-operation was 2.6%. The PTH episode most frequently occurred on postoperative days 5 and 6. The frequency of PTH was significantly higher in male patients and in adult. A stepwise multivariate logistic regression revealed that adult age and male gender were the independent risk factors for PTH. It also revealed that male gender and adult age were the independent risk factors for the category Ⅲ PTH. Conclusion Independent risk factors for PTH are adult age and male gender. The above two risk factorsarealso significant for category ⅢPTH.
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