【摘要】 目的 探讨腺样体和扁桃体消融切除术患儿术后发生3度以上出血的影响因素。方法 选取2018年1月至2023年12月首都儿科研究所附属儿童医院行腺样体和（或）扁桃体消融切除术患儿，根据术后是否发生3度及以上出血分为未出血组和出血组。采用倾向性得分匹配（prospensity score matching, PSM）1∶4的比例进行匹配，采用多因素logistic回归方程分析腺样体和（或）扁桃体消融切除患儿术后发生3度及以上出血的影响因素。结果 共纳入患儿7 805例，其中男5 087例、女2 718例，年龄1～18岁，平均（5.6±2.1）岁，发生3度及以上术后出血26例（3.3‰），原发性出血22例（84.6%），其中14例发生于术后6 h内；继发性出血4例（15.4%），均发生于术后5.5～9 d。PSM共成功匹配26对。多因素logistic回归分析结果显示，BMI越大（OR=18.266,95%CI:1.502～22.099,P=0.023）、手术部位为扁桃体伴或不伴腺样体切除（OR=42.540,95%CI:35.585～49.938,P <0.001）的患儿，术后发生3度及以上出血的风险越高。结论 腺样体和（或）扁桃体消融切除术患儿术后3度及以上出血的发生率较低，主要发生于术后24 h内。BMI和手术部位是术后发生3度及以上出血的影响因素。更多还原

【Abstract】 Objective To explore the influencing factors of postoperative hemorrhage with degree 3 or above in children with adenoidectomy and/or tonsillectomy. Methods Children who underwent adenoidectomy and/or tonsillectomy in Children’s Hospital, Capital Institute of Pediatrics from January 2018 to December 2023 were selected, and were divided into non-bleeding group and bleeding group according to whether postoperative hemorrhage with degree 3 or above occurred or not. The ratio of propensity score matching(PSM) was 1: 4, and influencing factors of postoperative hemorrhage with degree 3 or above in children with adenoidectomy and/or tonsillectomy were analyzed by multivariate logistic regression equation. Results A total of 7 805 children were included, there were 5 087 males and 2 718 females,aged from 1 to 18 years, with an average age of(5.6 ± 2.1)years. There were 26 cases of postoperative hemorrhage with degree 3 or above, and the incidence rate was 3.3‰. There were 22 cases(84.6%) of primary bleeding, of which 14 cases occurred within 6 h after operation and four cases(15.4%) of secondary bleeding, all of which occurred at 5.5-9 d after operation. A total of 26 pairs were successfully matched by PSM. Multivariate logistic regression analysis results showed that children with higher BMI(OR = 18.266,95%CI: 1.502-22.099,P = 0.023)and the surgical site involves tonsillectomy with or without adenoidectomy(OR = 42.540,95%CI: 35.585-49.938,P < 0.001)had higher risks of postoperative hemorrhage with degree 3 or above. Conclusions The incidence of postoperative hemorrhage with degree 3 or above in children with adenoidectomy and/or tonsillectomy is low, and mainly occurred within 24 h after the operation. BMI and surgical site are the influencing factors of postoperative hemorrhage with degree 3 or above.更多还原