术腔缝合止血对TLTPRA术后迟发出血及凝血的影响
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摘要
目的:探讨术腔缝合止血对扁桃体低温等离子射频切除术(TLTPRA)后迟发出血的预防效果及对凝血的影响。方法:选择行TLTPRA的慢性扁桃体炎患者104例并随机分为对照组(n=52例)和观察组(n=52例)。对照组采用电凝止血,观察组采用术腔缝合止血。记录两组手术到治疗后3 d出血量、治疗前和术后3 d的炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6、IL-8和C-反应蛋白(CRP)]、血栓弹力图[反应时间(R)、凝血块形成时间(K)、角度(Alpha)、最大振幅(MA值)和凝血综合指数(CI)]及凝血指标[凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)、活化部分凝血酶时间(APTT)及凝血酶原国际标准化比率(INR)]。结果:观察组手术到治疗后3 d的出血量低于对照组(P<0. 05),治疗前,两组炎症因子、血栓弹力图和凝血指标差异无统计学意义(P>0. 05),治疗后,与对照组比,观察组的TNF-α、IL-6、IL-8和CRP均明显降低(P>0. 05),观察组的血栓弹力图参数和凝血指标无明显变化,对照组的R、MA、CI、PT、TT、APTT和INR均明显增高(P<0. 05)。结论:术腔缝合止血可预防TLTPRA术后迟发性出血,帮助患者快速止血,有助于稳定血栓弹力图及凝血指标,值得推广应用。
Objective: To investigate the clinical effects of suture of the operating cavity on delayed bleeding after radiofrequency ablation of tonsil and its effect on blood coagulation factors.Methods: A total of104 cases chronic tonsillitis patients with radiofrequency ablation of tonsils were selected and randomely divided into the control group(n=52) and the observation group(n=52). The control group was treated with electrocoagulation and the observation group was treated with suture of the operating cavity to stop bleeding. The amount of bleeding of all patients were recorded three days after treatment.The inflammatory factors(TNF-α, IL-6, IL-8 and CRP), the thromboelastogram indices(R, K, Alpha, MA value, and CI), and coagulation parameters(PT, TT, FIB, APTT and INR) in all patients were determined before and 3 days after treatment.Results: The amount of bleeding in the observation group was lower than that in control group three days after treatment(P<0. 05). Before treatment, there were no significant differences in inflammatory factors, thromboelastogram and coagulation parameters between the two groups(P>0. 05). After treatment, compared with those in control group, the TNF-α, IL-6, IL-8 and CRP in the observation group decreased(P<0. 05). No significant changes were found in thromboelastogram parameters and coagulation indices in observation group after treatment(P>0. 05). But the R, MA, CI, PT, TT, APTT and INR of the control group increased significantly after treatment(P<0. 05).Conclusion: The suture of the operating cavity can be used in preventing delayed hemorrhage after TLTPRA in chronic tonsillitis patients. It can help stop bleeding quickly, and stabilize the thrombus elasticity map and coagulation indices.
Objective: To investigate the clinical effects of suture of the operating cavity on delayed bleeding after radiofrequency ablation of tonsil and its effect on blood coagulation factors.Methods: A total of104 cases chronic tonsillitis patients with radiofrequency ablation of tonsils were selected and randomely divided into the control group(n=52) and the observation group(n=52). The control group was treated with electrocoagulation and the observation group was treated with suture of the operating cavity to stop bleeding. The amount of bleeding of all patients were recorded three days after treatment.The inflammatory factors(TNF-α, IL-6, IL-8 and CRP), the thromboelastogram indices(R, K, Alpha, MA value, and CI), and coagulation parameters(PT, TT, FIB, APTT and INR) in all patients were determined before and 3 days after treatment.Results: The amount of bleeding in the observation group was lower than that in control group three days after treatment(P<0. 05). Before treatment, there were no significant differences in inflammatory factors, thromboelastogram and coagulation parameters between the two groups(P>0. 05). After treatment, compared with those in control group, the TNF-α, IL-6, IL-8 and CRP in the observation group decreased(P<0. 05). No significant changes were found in thromboelastogram parameters and coagulation indices in observation group after treatment(P>0. 05). But the R, MA, CI, PT, TT, APTT and INR of the control group increased significantly after treatment(P<0. 05).Conclusion: The suture of the operating cavity can be used in preventing delayed hemorrhage after TLTPRA in chronic tonsillitis patients. It can help stop bleeding quickly, and stabilize the thrombus elasticity map and coagulation indices.
引文
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[5]郭斌,张英.鼻内镜下低温等离子射频消融与传统方式切除鼻前庭囊肿的临床疗效观察[J].中国内镜杂志,2017,23(5):53-56.Guo B, Zhang Y. Comparison between low temperature-controlled plasma radio frequency ablation by nasal endoscopy and traditional way in treatment of nasal vestibular cyst[J]. China Journal of Endoscopy, 2017, 23(5):53-56.
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[7]朱怡霏,李莉.低温等离子射频消融术治疗小儿鼾症围手术期的护理体会[J].中国医科大学学报,2016,45(11):1 049-1 050.Zhu YF, Li L. Perioperative nursing of low temperature plasma radiofrequency ablation for the treatment of child sleep apnea[J]. Journal of China Medical University, 2016,45(11):1 049-1 050.
[8] Lu Yx, Gu Ql, Du J, et al. Upper airway cough syndrome in children and two inflammatory factors:TRPV1 and TGF-β2[J]. Int J Pediatr Otorhinolaryngol, 2014,78(3):445-450.
[9] Sacher F, Roberts-Thomson K, Maury P, et al. Epicardial ventricular tachycardia ablation a multicenter safety study[J]. J Am Coll Cardiol, 2017,55(21):2 366-2 372.
[10]李五一,霍红,杨大海,等.等离子射频辅助经口内镜微创切除浅表舌根肿瘤[J].中华耳鼻咽喉头颈外科杂志,2017,52(5):332-336.Li WY, Huo H, Yang DH, et al. Transoral coblationassisted endoscopic minimally invasive surgery for superficial tongue base tumours[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2017,52(5):332-336.
[11]张剑伟,徐金,张其昌,等.单极电刀凝切术与传统剥离切除术在儿童扁桃体手术中的比较[J].中国微创外科杂志,2016,16(2):158-160.Zhang JW, Xu J, Zhang QC, et al. Comparison between monopole electrocoagulation and conventional tonsillectomy in children[J]. Chinese Journal of Minimally Invasive Surgery, 2016,16(2):158-160.
[2] Wallace AN, Huang AJ, Vaswani D, et al. Combination acetabular radiofrequency ablation and cementoplasty using a navigational radiofrequency ablation device and ultrahigh viscosity cement:technical note[J]. Skeletal Radiology, 2016,45(3):401-405.
[3]刘学军,黄赛瑜,高金建,等.鼻内镜下低温等离子射频消融术治疗儿童鼾症的疗效及术后反应观察[J].中国内镜杂志,2016,22(6):5-8.Liu XJ, Huang SY, Gao JJ, et al. Effect and postoperative reaction of nasal endoscopic low temperature plasma radiofrequency ablation on children with snoring[J].China Journal of Endoscopy, 2016,22(6):5-8.
[4]张英,郭斌.显微喉镜下低温等离子射频治疗舌根囊肿的疗效观察[J].中国内镜杂志,2016,22(9):35-38.Zhang Y, Guo B. Efficacy of microlaryngoscopy radiofrequency in treatment of patients with tongue base cysts[J]. China Journal of Endoscopy, 2016,22(9):35-38.
[5]郭斌,张英.鼻内镜下低温等离子射频消融与传统方式切除鼻前庭囊肿的临床疗效观察[J].中国内镜杂志,2017,23(5):53-56.Guo B, Zhang Y. Comparison between low temperature-controlled plasma radio frequency ablation by nasal endoscopy and traditional way in treatment of nasal vestibular cyst[J]. China Journal of Endoscopy, 2017, 23(5):53-56.
[6]陈德尚,方平,马士崟.鼻内镜下单极电刀切除儿童扁桃体的临床观察[J].中国内镜杂志,2016,22(10):16-19.Chen SD, Fang P, Ma SY. Clinical observation on children tonsillectomy tonsil with single pole electric knife under nasal endoscopy[J]. China Journal of Endoscopy, 2016,22(10):16-19.
[7]朱怡霏,李莉.低温等离子射频消融术治疗小儿鼾症围手术期的护理体会[J].中国医科大学学报,2016,45(11):1 049-1 050.Zhu YF, Li L. Perioperative nursing of low temperature plasma radiofrequency ablation for the treatment of child sleep apnea[J]. Journal of China Medical University, 2016,45(11):1 049-1 050.
[8] Lu Yx, Gu Ql, Du J, et al. Upper airway cough syndrome in children and two inflammatory factors:TRPV1 and TGF-β2[J]. Int J Pediatr Otorhinolaryngol, 2014,78(3):445-450.
[9] Sacher F, Roberts-Thomson K, Maury P, et al. Epicardial ventricular tachycardia ablation a multicenter safety study[J]. J Am Coll Cardiol, 2017,55(21):2 366-2 372.
[10]李五一,霍红,杨大海,等.等离子射频辅助经口内镜微创切除浅表舌根肿瘤[J].中华耳鼻咽喉头颈外科杂志,2017,52(5):332-336.Li WY, Huo H, Yang DH, et al. Transoral coblationassisted endoscopic minimally invasive surgery for superficial tongue base tumours[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2017,52(5):332-336.
[11]张剑伟,徐金,张其昌,等.单极电刀凝切术与传统剥离切除术在儿童扁桃体手术中的比较[J].中国微创外科杂志,2016,16(2):158-160.Zhang JW, Xu J, Zhang QC, et al. Comparison between monopole electrocoagulation and conventional tonsillectomy in children[J]. Chinese Journal of Minimally Invasive Surgery, 2016,16(2):158-160.