Eberl W, Wendt I, Schroeder H-G
Klinik für Kinder- und Jugendmedizin, Klinikum Braunschweig gGmbH.
Klin Padiatr. 2005 Jan-Feb;217(1):20-4. doi: 10.1055/s-2004-818789.
Laboratory tests are widely used to screen children with planned surgery to detect unknown coagulation defects. This study investigates the predictive value of commonly used coagulation tests (thromboplastin time, partial thromboplastin time and thrombocyte count) compared with a standardized bleeding history.
In 702 patients 500 adenoidectomies and 500 tonsillectomies were done, results of laboratory evaluation and individual bleeding history were evaluated.
9.4 % of all laboratory tests showed abnormal results. 30.5 % of the children awaiting adenoidectomy had a suspicious bleeding history as had 22 % of patients undergoing tonsillectomy. In the clinical course of adenoidectomy no bleeding occurred. After tonsillectomy 15 children (3 %) showed moderate, 12 patients (2.4 %) severe postoperative bleeding. The positive predictive value of coagulation screening reached 6.8 % whereas history alone predicted 9.2 % of observed post tonsillectomy bleeding.
The results of this study demonstrate the lacking effect of laboratory tests to predict postoperative bleeding complications. Taking a careful history of bleeding risks and testing only patients with suspicious history reduces the risk of bleeding more effective. Counseling about bleeding symptoms and postoperative survey of patients are additional measures which may protect the children.
实验室检查广泛应用于对计划接受手术的儿童进行筛查，以检测未知的凝血缺陷。本研究调查了常用凝血检查（凝血酶原时间、部分凝血活酶时间和血小板计数）与标准化出血史相比的预测价值。
对702例患者进行了500例腺样体切除术和500例扁桃体切除术，并评估了实验室检查结果和个体出血史。
所有实验室检查中9.4%显示异常结果。等待腺样体切除术的儿童中有30.5%有可疑出血史，扁桃体切除术患者中有22%有可疑出血史。在腺样体切除术中未发生出血。扁桃体切除术后，15名儿童（3%）出现中度出血，12名患者（2.4%）出现严重术后出血。凝血筛查的阳性预测值为6.8%，而仅根据病史可预测9.2%的扁桃体切除术后出血。
本研究结果表明实验室检查对预测术后出血并发症缺乏效果。仔细询问出血风险病史并仅对有可疑病史的患者进行检查能更有效地降低出血风险。对出血症状进行咨询以及对患者进行术后监测是保护儿童的额外措施。
