Pädiatrische Hämostaseologie, Dr. von Haunersches Kinderspital, Lindwurmstr. 4, 80337 München.
Hamostaseologie. 2010 Nov;30 Suppl 1:S108-11.
Bleeding after ear-nose-and throat surgery in children is a serious complication. With the help of the German Surveillance Unit for Rare Paediatric Disorders (Erhebungseinheit für seltene pädiatrische Erkrankungen in Deutschland; ESPED) a two year survey was performed to record the incidence, severity, reasons and treatment of haemorrhages. During the study period, 1069 bleeds were reported from 720 paediatric hospitals and departments of otorhinolaryngology after adenoidectomy and tonsillectomy. 713 reports could be analyzed. Two deaths occurred after adenoidectomy. Although laboratory screening was performed in more than 70% of all cases, bleeding complications were neither foreseeable nor preventable. Inherited coagulopathies were rare and in most cases not detected, neither by laboratory screening nor by taking a history. Since preoperative measures cannot help much to improve the situation, all efforts have to be taken to improve the postoperative period, especially since more than 20% of the hemorrhages occurred during weekends. Guidelines on postoperative care and behaviour should therefore be implemented and parents and patients must be informed on bleeding risks and on what to do in case of emergency. If bleeding occurs, extensive coagulation testing is mandatory.
儿童耳鼻喉手术后出血是一种严重的并发症。在德国罕见儿科疾病监测单位（Erhebungseinheit für seltene pädiatrische Erkrankungen in Deutschland；ESPED）的帮助下，进行了一项为期两年的调查，以记录出血的发生率、严重程度、原因和治疗方法。在研究期间，720 家耳鼻喉科医院和部门报告了 1069 例腺样体切除术和扁桃体切除术后的出血事件。其中 713 例报告可进行分析。腺样体切除术后发生了 2 例死亡。尽管在超过 70%的病例中进行了实验室筛查，但出血并发症既不可预见也不可预防。遗传性凝血障碍很少见，而且大多数情况下无法通过实验室筛查或病史调查检测到。由于术前措施对改善这种情况帮助不大，因此必须尽一切努力改善术后阶段，特别是因为超过 20%的出血发生在周末。因此，应制定术后护理和行为指南，并告知家长和患者出血风险以及出现紧急情况时该怎么做。如果发生出血，必须进行广泛的凝血检测。
