Gross C W, Gallagher R, Schlosser R J, Burks S G, Flanagan H L, Mintz P D, Avery N L, Mayers S L, Spotnitz W D
Department of Otolaryngology, University of Virginia Health System, Charlottesville 22908, USA.
Laryngoscope. 2001 Feb;111(2):259-63. doi: 10.1097/00005537-200102000-00014.
OBJECTIVES/HYPOTHESIS: Pain is a major cause of morbidity after tonsillectomy. Although various efforts have been made to reduce pain, the use of oral analgesics, which can have adverse side effects, remains the standard of care. It is hypothesized that fibrin sealant, used to achieve hemostasis and enhance healing in many surgical procedures, might help decrease pain after this operation.
A prospective, randomized, blinded study was performed on 20 children aged 5 to 17 years who were undergoing tonsillectomy, to evaluate the efficacy of FIBRIN SEALANT in reducing postoperative pain.
All patients pre-donated 40 mL of blood from which autologous concentrated fibrinogen was prepared by cryoprecipitation. In the fibrin sealant group, fibrinogen and topical bovine thrombin were sprayed onto the surgical site to form fibrin sealant at the conclusion of tonsillectomy. The 10 patients in the control group (C) received no fibrin sealant. Patients rated their level of pain immediately after surgery and at regular intervals for 3 days after surgery using the Wong-Baker Faces Pain Rating Scale (1-6). Emesis, postoperative bleeding, medications, and adverse events were also evaluated.
At 7.00 P.M. on postoperative day (POD) 0, the mean +/- SD fibrin sealant group pain score (2.9+/-0.41 units) was significantly lower than for the C group (4.1+/-0.43 units; P < or = .05). There was also a trend in favor of less pain in the fibrin sealant group at 7:00 P.M. on POD 1, with a mean of 3.5+/-0.43 units versus 2.4+/-0.48 units for C (P = .15). The odds of a patient in C experiencing emesis were 8.16 times higher, (P < or = .05) than for patients in the fibrin sealant group.
Fibrin sealant significantly reduced pain the evening after pediatric tonsillectomy and also decreased the chance of experiencing emesis. Thus fibrin sealant may be clinically useful as an adjunct to tonsillectomy.
目的/假设：疼痛是扁桃体切除术后发病的主要原因。尽管已做出各种努力来减轻疼痛，但使用可能有不良副作用的口服镇痛药仍是护理标准。据推测，在许多外科手术中用于实现止血和促进愈合的纤维蛋白封闭剂可能有助于减轻该手术后的疼痛。
对20名年龄在5至17岁接受扁桃体切除术的儿童进行了一项前瞻性、随机、双盲研究，以评估纤维蛋白封闭剂在减轻术后疼痛方面的疗效。
所有患者预先捐献40毫升血液，通过冷沉淀法从中制备自体浓缩纤维蛋白原。在纤维蛋白封闭剂组中，在扁桃体切除术后将纤维蛋白原和局部牛凝血酶喷洒到手术部位以形成纤维蛋白封闭剂。对照组（C组）的10名患者未接受纤维蛋白封闭剂。患者在手术后立即以及术后3天定期使用面部表情疼痛评分量表（1 - 6分）对自己的疼痛程度进行评分。还对呕吐、术后出血、用药情况和不良事件进行了评估。
术后第0天晚上7点，纤维蛋白封闭剂组的平均疼痛评分（2.9 ± 0.41分）显著低于C组（4.1 ± 0.43分；P ≤ 0.05）。术后第1天晚上7点，纤维蛋白封闭剂组也有疼痛较轻的趋势，平均评分为3.5 ± 0.43分，而C组为2.4 ± 0.48分（P = 0.15）。C组患者呕吐的几率比纤维蛋白封闭剂组患者高8.16倍（P ≤ 0.05）。
纤维蛋白封闭剂显著减轻了小儿扁桃体切除术后当晚的疼痛，也降低了呕吐的几率。因此，纤维蛋白封闭剂作为扁桃体切除术的辅助手段可能在临床上有用。
