Close H L, Kryzer T C, Nowlin J H, Alving B M
Otolaryngology-Head and Neck Surgery Service, Walter Reed Army Medical Center, Washington, DC.
Otolaryngol Head Neck Surg. 1994 Dec;111(6):733-8. doi: 10.1177/019459989411100606.
The purpose of this prospective study in patients undergoing tonsillectomy was to determine whether perioperative bleeding could be predicted by use of a standardized questionnaire concerning bleeding risk combined with measurement of the activated partial thromboplastin time and prothrombin time. Of the 96 patients enrolled in the study, none had a history of a severe bleeding disorder, but 6 (6%) had histories suggestive of a mild bleeding disorder. Further evaluation showed possible von Willebrand's disease in one of these patients. Of the 90 patients with negative questionnaires, 16% had prolongation of the activated partial thromboplastin time. One of these patients had possible von Willebrand's disease. However, none of the patients with positive questionnaires or a prolonged activated partial thromboplastin time bled after surgery. Bleeding that resulted in additional hospital use occurred in 2% of patients, and blood-tinged sputum was described by 4% after discharge; all of these patients had negative questionnaires and normal screening studies. The data provide further evidence that routine measurement of the activated partial thromboplastin time and prothrombin time in asymptomatic patients is not useful for predicting postoperative bleeding. In addition, histories suggestive of a mild bleeding disorder are also not accurate predictors of postoperative bleeding. Excessive bleeding associated with tonsillectomy is usually not a result of an identifiable coagulation disorder.
这项针对接受扁桃体切除术患者的前瞻性研究的目的是，确定使用一份关于出血风险的标准化问卷并结合活化部分凝血活酶时间和凝血酶原时间的测量，是否能够预测围手术期出血情况。在该研究纳入的96例患者中，无人有严重出血性疾病史，但有6例（6%）有提示轻度出血性疾病的病史。进一步评估显示，其中1例患者可能患有血管性血友病。在问卷结果为阴性的90例患者中，16%的患者活化部分凝血活酶时间延长。其中1例患者可能患有血管性血友病。然而，问卷结果为阳性或活化部分凝血活酶时间延长的患者术后均未出血。导致额外住院治疗的出血发生在2%的患者中，4%的患者出院后出现痰中带血；所有这些患者问卷结果均为阴性且筛查检查正常。这些数据进一步证明，对无症状患者常规测量活化部分凝血活酶时间和凝血酶原时间对预测术后出血并无用处。此外，提示轻度出血性疾病的病史也不是术后出血的准确预测指标。与扁桃体切除术相关的过度出血通常并非由可识别的凝血障碍所致。
