经低温射频消融术行扁桃体切除术患者术前血栓弹力描记术预测术后出血的回顾性分析。
Preoperative thromboelastography in the prediction of post-tonsillectomy hemorrhage by coblation tonsillectomy: a post-hoc analysis.
机构信息
From the Department of Otolaryngology, Shenzhen People's Hospital, Shenzhen, China.
From the Department of Otolaryngology, 8th Medical Center, PLA General Hospital, Beijing, China.
出版信息
Ann Saudi Med. 2022 Nov-Dec;42(6):377-384. doi: 10.5144/0256-4947.2022.377. Epub 2022 Dec 1.
BACKGROUND
Post-tonsillectomy hemorrhage (PTH) affects around 4% of patients after tonsillectomy. We hypothesized that preoperative thromboelastography (TEG) might identify patients at higher risk of PTH.
OBJECTIVE
Investigate whether evaluation of coagulation function by preoperative TEG might help to predict PTH after tonsillectomy by coblation tonsillectomy (TE).
DESIGN
Post-hoc analysis of randomized controlled study.
SETTING
Otolaryngology Department between January 2017 and August 2019.
PATIENTS AND METHODS
This post-hoc analysis included adults who underwent coblation TE for benign tonsillar disorders. Routine blood tests and TEG were performed preoperatively. The TEG parameters evaluated included coagulation reaction time (R) and maximum thrombus amplitude (MA).
MAIN OUTCOME MEASURES
The main outcome was PTH during the 4-week postoperative period.
SAMPLE SIZE AND CHARACTERISTICS
284 RESULTS: The 19 patients (6.7%) that experienced PTH had a higher prevalence of diabetes mellitus, lower use of intraoperative suturing, fewer patients with grade I and II tonsillar enlargement, a higher white blood cell count, lower platelet count, lower fibrinogen level, lower R value, and a lower MA value than patients without PTH (all <.05). Multivariate logistic regression revealed that diabetes mellitus (<.053), fibrinogen level ≤2.735 g/L (<.027), R≤6.55 min (<.011) and MA≤59.15 mm (<.012) were independently associated with PTH. A regression model incorporating these four factors predicted PTH with a sensitivity of 73.7% and specificity of 83.8%.
CONCLUSION
Preoperative evaluation of diabetes mellitus history, fibrinogen level, and TEG parameters might help to identify patients at higher risk of PTH after coblation TE.
LIMITATIONS
Single-center study with a small sample size; possibly underpowered statistically. TEG measurements might not accurately reflect coagulation function, and a validation cohort was unavailable.
CONFLICT OF INTEREST
None. CHINESE CLINICAL TRIAL REGISTRY NUMBER OF STUDY USED IN THIS ANALYSIS: ChiCTR2000032171. http://www.chictr.org.cn/showprojen.aspx?proj=52553.
背景
扁桃体切除术后出血（PTH）影响约 4%的扁桃体切除术后患者。我们假设术前血栓弹性描记术（TEG）可能可以识别出发生 PTH 风险较高的患者。
目的
通过使用等离子刀扁桃体切除术（TE）研究术前 TEG 评估凝血功能是否有助于预测扁桃体切除术后 PTH。
设计
随机对照研究的事后分析。
设置
2017 年 1 月至 2019 年 8 月耳鼻喉科。
患者和方法
本事后分析纳入了因良性扁桃体疾病行等离子刀 TE 的成人患者。术前进行常规血液检查和 TEG。评估的 TEG 参数包括凝血反应时间（R）和最大血栓振幅（MA）。
主要观察指标
术后 4 周内 PTH 是主要观察结果。
样本量和特征
284 例
结果
19 例（6.7%）发生 PTH 的患者糖尿病患病率较高，术中缝合使用率较低，I 级和 II 级扁桃体肿大患者较少，白细胞计数较高，血小板计数较低，纤维蛋白原水平较低，R 值较低，MA 值较低（均<.05）。多变量逻辑回归显示，糖尿病（<.053）、纤维蛋白原水平≤2.735 g/L（<.027）、R≤6.55 min（<.011）和 MA≤59.15 mm（<.012）与 PTH 独立相关。包含这四个因素的回归模型预测 PTH 的敏感性为 73.7%，特异性为 83.8%。
结论
术前评估糖尿病病史、纤维蛋白原水平和 TEG 参数可能有助于识别等离子刀 TE 后发生 PTH 风险较高的患者。
局限性
单中心研究，样本量小；统计学上可能功率不足。TEG 测量可能无法准确反映凝血功能，且缺乏验证队列。
利益冲突
无。
本分析中使用的研究中国临床试验注册号
ChiCTR2000032171。http://www.chictr.org.cn/showprojen.aspx?proj=52553。
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