Stephens J C, Georgalas C, Kyi M, Ghufoor K
Department of ENT, Charing Cross Hospital, London, UK.
J Laryngol Otol. 2008 Apr;122(4):383-7. doi: 10.1017/S0022215107007311. Epub 2007 Apr 20.
To identify if there is a link between bacterial colonisation of the tonsillar fossa and post-tonsillectomy haemorrhage.
Prospective non-interventional study of 105 patients who underwent tonsillectomy during a seven-month period. The study took place in a secondary care centre, the West Middlesex University Hospital.
The participants were 105 patients who consecutively underwent tonsillectomy. The exclusion criteria were any patients with suspected or known malignancy, or known bleeding dyscrasias. The participants underwent microbiological sampling of the tonsil pre-operatively.
The outcome measures were primary or secondary bleeding, defined as any evidence of haemorrhage in the tonsillar fossae.
Twenty-four per cent of patients undergoing tonsillectomy had positive cultures from their tonsils pre-operatively. Patients with bacterial colonisation of the tonsillar fossa pre-operatively had an increased rate of post-tonsillectomy haemorrhage (odds ratio: 3.8, 1.1-12.1, 95 per cent confidence intervals, p = 0.04).
This prospective study has found a relationship between bacterial colonisation of the tonsillar fossa and post-tonsillectomy haemorrhage. This suggests that there may be an argument for the use of antibiotics in those cases with positive pre-operative cultures. In view of the types of pathogens isolated, we feel that the management of a post-tonsillectomy bleed should include a beta lactamase inhibiting antibiotic.
确定扁桃体窝细菌定植与扁桃体切除术后出血之间是否存在关联。
对105例在7个月期间接受扁桃体切除术的患者进行前瞻性非干预性研究。该研究在二级护理中心西米德塞克斯大学医院进行。
参与者为105例连续接受扁桃体切除术的患者。排除标准为任何疑似或已知患有恶性肿瘤或已知有出血性疾病的患者。参与者在术前接受扁桃体的微生物采样。
观察指标为原发性或继发性出血，定义为扁桃体窝有任何出血迹象。
24%接受扁桃体切除术的患者术前扁桃体培养呈阳性。术前扁桃体窝有细菌定植的患者扁桃体切除术后出血率增加（比值比：3.8，1.1 - 12.1，95%置信区间，p = 0.04）。
这项前瞻性研究发现扁桃体窝细菌定植与扁桃体切除术后出血之间存在关联。这表明对于术前培养呈阳性的病例，可能有理由使用抗生素。鉴于分离出的病原体类型，我们认为扁桃体切除术后出血的处理应包括使用β-内酰胺酶抑制抗生素。
