口蓋扁桃摘出術の術後出血: 抗生剤投与方法からみた検討
口蓋扁桃摘出術における周術期抗生剤の投与期間を手術当日のみから術後3日以上に延長, 術後経過をカルテで追跡した. その結果, 抗生剤投与日数を3日以上に延長しても術後出血率, 解熱鎮痛剤使用数, 発熱の有無に影響がみられなかった. 周術期の抗生剤投与は手術当日のみで十分と考えられたが, 術後出血例の検討では局所感染を伴うものもあった. 術前より術野の常在菌叢, 薬剤感受性を把握し最適な抗生剤を使用するなど症例毎に感染対策を行うことが良いと思われた. 一方, 抗生剤使用期間にかかわらず, 解熱鎮痛剤の使用が多いと, 有意に術後出血が増加した. その原因は不明であり解熱鎮痛剤の抗血小板作用なども含...
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| Published in | Stomato-pharyngology Vol. 22; no. 2; pp. 109 - 115 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本口腔・咽頭科学会
2009
Japan Society of Stomato-pharyngology |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0917-5105 1884-4316 |
| DOI | 10.14821/stomatopharyngology.22.109 |
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| Abstract | 口蓋扁桃摘出術における周術期抗生剤の投与期間を手術当日のみから術後3日以上に延長, 術後経過をカルテで追跡した. その結果, 抗生剤投与日数を3日以上に延長しても術後出血率, 解熱鎮痛剤使用数, 発熱の有無に影響がみられなかった. 周術期の抗生剤投与は手術当日のみで十分と考えられたが, 術後出血例の検討では局所感染を伴うものもあった. 術前より術野の常在菌叢, 薬剤感受性を把握し最適な抗生剤を使用するなど症例毎に感染対策を行うことが良いと思われた. 一方, 抗生剤使用期間にかかわらず, 解熱鎮痛剤の使用が多いと, 有意に術後出血が増加した. その原因は不明であり解熱鎮痛剤の抗血小板作用なども含め今後の検討を要する. |
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| AbstractList | 口蓋扁桃摘出術における周術期抗生剤の投与期間を手術当日のみから術後3日以上に延長, 術後経過をカルテで追跡した. その結果, 抗生剤投与日数を3日以上に延長しても術後出血率, 解熱鎮痛剤使用数, 発熱の有無に影響がみられなかった. 周術期の抗生剤投与は手術当日のみで十分と考えられたが, 術後出血例の検討では局所感染を伴うものもあった. 術前より術野の常在菌叢, 薬剤感受性を把握し最適な抗生剤を使用するなど症例毎に感染対策を行うことが良いと思われた. 一方, 抗生剤使用期間にかかわらず, 解熱鎮痛剤の使用が多いと, 有意に術後出血が増加した. その原因は不明であり解熱鎮痛剤の抗血小板作用なども含め今後の検討を要する. Objective: We determined whether prolonged periopearative antibiotic administration lessens post tonsillectomy hemorrhaging and other morbid outcomes.Subjects: Subjects were 177 tonsillectomy patients with a history of recurrent tonsillitis, peritonsillar abscess, chronic tonsillitis, or tonsillar hypertrophy. Surgeries were underwent between Apr. 2005 and Oct. 2007, or May and Aug. 2008.Methods: Subjects treated with cefazolin as prophylactic antibiotics were divided into two groups based on the duration of antibiotics administration. Group 1 was treated for 1 day (the day of surgery), and Group 2 was treated for 3 days or more with perioperative antibiotics. We analyzed morbid outcomes such as (1) secondary hemorrhage, (2) need for analgesics, and (3) fever over 38°C. We also analyzed the relationship between secondary hemorrhaging and the need for analgesics regardless of antibiotic treatment duration.Results: Of all subjects (n=177), 105 (59%) did not experience any secondary hemorrhaging, 63 (36%) experienced minor hemorrhaging which did not require treatment, and 9 (5%) experienced major hemorrhaging and required astriction or bipolar diathermy hemostasis. In Group 1 (n=92), 58 (63%) did not experience any secondary hemorrhaging, 30 (33%) experienced minor, and 4 (4%) experienced major hemorrhaging. In Group 2 (n=85), 47 (55%) did not experience any secondary hemorrhaging, 33 (39%) experienced minor, and 5 (6%) experienced major hemorrhaging. This result showed no significant difference between groups in the rate of secondary hemorrhaging. Similarly, between groups, no significant difference was seen in the degrees of need for analgesics, or fever over 38°C. We did however find local infection or halitosis in some secondary hemorrhaging in Group 1. We also found a significant difference in the need for analgesics among secondary hemorrhaging cases regardless of antibiotic treatment duration. Patients with severer hemorrhaging consumed analgesics significantly more frequently.Conclusions: Perioperative antibiotics administered for 3 days or more after tonsillectomy do not improve morbid outcomes such as the rate of secondary hemorrhaging, the need for analgesics, or fever over 38°C, compared to those administered only on the day of surgery. We also found that cases using analgesics more frequently increase the rate of secondary hemorrhaging. 口蓋扁桃摘出術における周術期抗生剤の投与期間を手術当日のみから術後3日以上に延長, 術後経過をカルテで追跡した. その結果, 抗生剤投与日数を3日以上に延長しても術後出血率, 解熱鎮痛剤使用数, 発熱の有無に影響がみられなかった. 周術期の抗生剤投与は手術当日のみで十分と考えられたが, 術後出血例の検討では局所感染を伴うものもあった. 術前より術野の常在菌叢, 薬剤感受性を把握し最適な抗生剤を使用するなど症例毎に感染対策を行うことが良いと思われた. 一方, 抗生剤使用期間にかかわらず, 解熱鎮痛剤の使用が多いと, 有意に術後出血が増加した. その原因は不明であり解熱鎮痛剤の抗血小板作用なども含め今後の検討を要する. |
| Author | 原田, 生功磨 國井, 博史 勝見, さち代 村上, 信五 小山, 新一郎 |
| Author_FL | Harata Ikuma Murakami Shingo Kunii Hiroshi Katsumi Sachiyo Oyama Shinichiro |
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| References | 4) Stavroulaki P, Skoulakis C, Theos E, et al. Thermal welding versus cold dissection tonsillectomy: a prospective, randomized, single-blind study in adult patients. Ann Otol Rhinol Laryngol 2007; 116: 565-570. 14) Ahsan F, Rashid, H, Eng, C, et al. Is secondary haemorrhage after tonsillectomy in adults an infective condition? Objective measures of infection in a prospective cohort Clin Otolaryngol 2007; 32: 24-27. 18) Tawalbeh MI, Nawasreh OO, Husban AM. Comparative study of diclofenac sodium and paracetamol for treatment of pain after adenotonsillectomy in children. Saudi Med J 2001; 22: 121-123. 22) Noguchi M, Kimoto A, Gierse JK, et al. Enzymologic and pharmacologic profile of loxoprofen sodium and its metabolites. Biol Pharm Bull 2005; 28: 2075-2079. 9) Arnoldner C, Grasl MCh, Thurnher D, et al. Surgical revision of hemorrhage in 8388 patients after cold-steel adenotonsillectomies. Wien Klin Wochenschr 2008; 120: 336-342. 3) Bhattacharyya N. Evaluation of post-tonsillectomy bleeding in the adult population. Ear Nose Throat J 2001; 80: 544-549. 19) Møiniche S, Rømsing J, Dahl JB, et al. Nonsteroidal antiinflammatory drugs and the risk of operative site bleeding after tonsillectomy: a quantitative systematic review. Tramèr MR. Anesth Analg 2003; 96: 68-77. 16) Jeong JH, Lee DW, Ryu RA. Bacteriologic comparison of tonsil core in recurrent tonsillitis and tonsillar hypertrophy. Laryngoscope 2007; 117: 2146-2151. 7) Demars SM, Harsha WJ, Crawford JV. The effects of smoking on the rate of postoperative hemorrhage after tonsillectomy and uvulopalatopharyngoplasty. Arch Otolaryngol Head Neck Surg 2008; 134: 811-814. 5) Bäck L, Paloheimo M, Ylikoski. Traditional tonsillectomy compared with bipolar radiofrequency thermal ablation tonsillectomy in adults: a pilot study J. Arch Otolaryngol Head Neck Surg 2001; 127: 1106-1112. 12) Iyer S, DeFoor W, Grocela J, et al. The use of perioperative antibiotics in tonsillectomy: does it decrease morbidity? Int J Pediatr Otorhinolaryngol 2006; 70: 853-861. 20) Harley EH, Dattolo RA. Ibuprofen for tonsillectomy pain in children: efficacy and complications. Otolaryngol Head Neck Surg 1998; 119: 492-496. 6) Collison PJ, Mettler B. Factors associated with post-tonsillectomy hemorrhage. Ear Nose Throat J 2000; 79: 640-642, 644, 646. 17) Courtney MJ, Cabraal D. Tramadol vs. diclofenac for posttonsillectomy analgesia. Arch Otolaryngol Head Neck Surg 2001; 127: 385-388. 21) Krishna S, Hughes LF, Lin SY. Postoperative hemorrhage with nonsteroidal anti-inflammatory drug use after tonsillectomy: a meta-analysis. Arch Otolaryngol Head Neck Surg 2003; 129: 1086-1089. 1) Telian SA, Handler SD, Fleisher GR, et al. The effect of antibiotic therapy on recovery after tonsillectomy in children. A controlled study Arch Otolaryngol Head Neck Surg 1986; 112: 610-615. 8) Myssiorek D, Alvi A. Post-tonsillectomy hemorrhage: an assessment of risk factors. Int J Pediatr Otorhinolaryngol 1996; 37: 35-43. 10) Dhiwakar M, Eng CY, Selvaraj S, et al. Antibiotics to improve recovery following tonsillectomy: a systematic review. Otolaryngol Head Neck Surg 2006; 134: 357-364. 15) Stephens JC, Georgalas C, Kyi M, et al. Is bacterial colonisation of the tonsillar fossa a factor in post-tonsillectomy haemorrhage? J Laryngol Otol 2008; 122: 383-387. 13) Al-Kindy SA. Do antibiotics decrease post-tonsillectomy morbidity? Saudi Med J 2002 ; 23: 705-707. 2) Woods RK, Dellinger EP. Current guidelines for antibiotic prophylaxis of surgical wounds. Am Fam Physician 1998; 57: 2731-2740. 11) Dhiwakar M, Clement WA, Supriya M, et al. Antibiotics to reduce post-tonsillectomy morbidity. Cochrane Database Syst Rev 2008; 16: CD005607. |
| References_xml | – reference: 21) Krishna S, Hughes LF, Lin SY. Postoperative hemorrhage with nonsteroidal anti-inflammatory drug use after tonsillectomy: a meta-analysis. Arch Otolaryngol Head Neck Surg 2003; 129: 1086-1089. – reference: 6) Collison PJ, Mettler B. Factors associated with post-tonsillectomy hemorrhage. Ear Nose Throat J 2000; 79: 640-642, 644, 646. – reference: 7) Demars SM, Harsha WJ, Crawford JV. The effects of smoking on the rate of postoperative hemorrhage after tonsillectomy and uvulopalatopharyngoplasty. Arch Otolaryngol Head Neck Surg 2008; 134: 811-814. – reference: 8) Myssiorek D, Alvi A. Post-tonsillectomy hemorrhage: an assessment of risk factors. Int J Pediatr Otorhinolaryngol 1996; 37: 35-43. – reference: 12) Iyer S, DeFoor W, Grocela J, et al. The use of perioperative antibiotics in tonsillectomy: does it decrease morbidity? Int J Pediatr Otorhinolaryngol 2006; 70: 853-861. – reference: 2) Woods RK, Dellinger EP. Current guidelines for antibiotic prophylaxis of surgical wounds. Am Fam Physician 1998; 57: 2731-2740. – reference: 11) Dhiwakar M, Clement WA, Supriya M, et al. Antibiotics to reduce post-tonsillectomy morbidity. Cochrane Database Syst Rev 2008; 16: CD005607. – reference: 20) Harley EH, Dattolo RA. Ibuprofen for tonsillectomy pain in children: efficacy and complications. Otolaryngol Head Neck Surg 1998; 119: 492-496. – reference: 19) Møiniche S, Rømsing J, Dahl JB, et al. Nonsteroidal antiinflammatory drugs and the risk of operative site bleeding after tonsillectomy: a quantitative systematic review. Tramèr MR. Anesth Analg 2003; 96: 68-77. – reference: 16) Jeong JH, Lee DW, Ryu RA. Bacteriologic comparison of tonsil core in recurrent tonsillitis and tonsillar hypertrophy. Laryngoscope 2007; 117: 2146-2151. – reference: 10) Dhiwakar M, Eng CY, Selvaraj S, et al. Antibiotics to improve recovery following tonsillectomy: a systematic review. Otolaryngol Head Neck Surg 2006; 134: 357-364. – reference: 3) Bhattacharyya N. Evaluation of post-tonsillectomy bleeding in the adult population. Ear Nose Throat J 2001; 80: 544-549. – reference: 17) Courtney MJ, Cabraal D. Tramadol vs. diclofenac for posttonsillectomy analgesia. Arch Otolaryngol Head Neck Surg 2001; 127: 385-388. – reference: 22) Noguchi M, Kimoto A, Gierse JK, et al. Enzymologic and pharmacologic profile of loxoprofen sodium and its metabolites. Biol Pharm Bull 2005; 28: 2075-2079. – reference: 13) Al-Kindy SA. Do antibiotics decrease post-tonsillectomy morbidity? Saudi Med J 2002 ; 23: 705-707. – reference: 1) Telian SA, Handler SD, Fleisher GR, et al. The effect of antibiotic therapy on recovery after tonsillectomy in children. A controlled study Arch Otolaryngol Head Neck Surg 1986; 112: 610-615. – reference: 14) Ahsan F, Rashid, H, Eng, C, et al. Is secondary haemorrhage after tonsillectomy in adults an infective condition? Objective measures of infection in a prospective cohort Clin Otolaryngol 2007; 32: 24-27. – reference: 4) Stavroulaki P, Skoulakis C, Theos E, et al. Thermal welding versus cold dissection tonsillectomy: a prospective, randomized, single-blind study in adult patients. Ann Otol Rhinol Laryngol 2007; 116: 565-570. – reference: 9) Arnoldner C, Grasl MCh, Thurnher D, et al. Surgical revision of hemorrhage in 8388 patients after cold-steel adenotonsillectomies. Wien Klin Wochenschr 2008; 120: 336-342. – reference: 5) Bäck L, Paloheimo M, Ylikoski. Traditional tonsillectomy compared with bipolar radiofrequency thermal ablation tonsillectomy in adults: a pilot study J. Arch Otolaryngol Head Neck Surg 2001; 127: 1106-1112. – reference: 15) Stephens JC, Georgalas C, Kyi M, et al. Is bacterial colonisation of the tonsillar fossa a factor in post-tonsillectomy haemorrhage? J Laryngol Otol 2008; 122: 383-387. – reference: 18) Tawalbeh MI, Nawasreh OO, Husban AM. Comparative study of diclofenac sodium and paracetamol for treatment of pain after adenotonsillectomy in children. Saudi Med J 2001; 22: 121-123. |
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| Snippet | 口蓋扁桃摘出術における周術期抗生剤の投与期間を手術当日のみから術後3日以上に延長, 術後経過をカルテで追跡した. その結果, 抗生剤投与日数を3日以上に延長しても術後... Objective: We determined whether prolonged periopearative antibiotic administration lessens post tonsillectomy hemorrhaging and other morbid outcomes.Subjects:... |
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| SubjectTerms | analgesics antibiotics hemorrhage tonsillectomy 口蓋扁桃摘出術 抗生剤 術後出血 解熱鎮痛剤 |
| Title | 口蓋扁桃摘出術の術後出血: 抗生剤投与方法からみた検討 |
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