儿童阻塞性睡眠呼吸暂停低通气综合征的治疗  

Treatment of pediatric obstructive sleep apnea hypopnea syndrome

作　　者：蔡晓岚[1] 刘洪英[2] 范献良[1] 王廷础[1] 

机构地区：[1]山东大学卫生部耳鼻咽喉科学重点实验室,济南250012 [2]济南铁路局中心医院耳鼻咽喉科

出　　处：《中华耳鼻咽喉科杂志》2004年第8期496-500,共5页Chinese Journal of Otorhinolaryngology

摘　　要：目的 探讨儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopneasyndrome,OSAHS)患儿的治疗方法和疗效观察。方法 经多道睡眠监测(polysomnography,PSG)确诊的4-12岁OSAHS患儿59例:扁桃体切除和(或)经口内镜(内窥镜,下同)引导下腺样体刮除54例;选择长期正压通气治疗(continue positive airway pressure,CPAP)2例;保守治疗3例。采用儿童OSAHS生活质量调查表(quality of life for children with obstructive sleep apnea 18 items,OSA-18)对患儿进行治疗前后的随访。结果 围手术期无术后出血、急性呼吸道梗阻发生。随访12-18个月,手术患儿无鼻咽闭锁、咽鼓管功能障碍、腺样体残留等并发症;OSA-18调查评分显示:治疗后76.3％(45例)的患儿生活质量总体指标,88.1％(52例)的患儿睡眠呼吸障碍,67.8％(40例)的患儿身体症状得到显著改善。长期CPAP治疗的有效治疗压力在5.6-7.8 em H2O左右。3例保守治疗者略有改善。结论 手术切除引起上气道阻塞的肥大的扁桃体和(或)腺样体是儿童OSAHS有效的治疗手段之一,纤维鼻咽镜检查、头颅侧位X线摄片有助于手术适应证的确定。经口内镜引导下腺样体刮除术具有直视下操作,视野清晰,切除彻底,可避免损伤周围重要结构的特点。Objective To evaluate treatment options of pediatric obstructive sleep apnea hypopnea syndrome (OSAHS) and their curative effect. Methods In this study, there are 59 confirmed pediatric obstructive sleep apnea hypopnea syndrome cases diagnosed by polysomnography ( PSG). Among them, 54 cases were treated by tonsillectomy or/and adenoidectomy directed by transoral endoscopy. Continue positive airway pressure ( CPAP) was used for 2 cases in long-term. Three cases were treated with other conservative therapy. OSA-18 (quality of life for children with obstructive sleep apnea 18 items) was adopted as a disease-specific quality-of-life follow-up survey before and after treatment. Results During perioperation period, no postoperative bleeding or acute respiratory obstruction occurred . Follow-up sleep study was carried out 12-18 months postoperatively, no complications of velopharyngeal insufficiency, nasopharyngeal stenosis or residual adenoid were found. OSA-18 scores showed that quality of life had been significant improved after operation in 76.3% (45 cases), sleep disturbance in 88.1% (52 cases) and physical symptoms in 67. 8% (40 cases) . The pressure level of long-term CPAP in 2 cases was about 5. 6-7. 8 cmH2O. 3 cases were slightly improved treated with conservative therapy. Conclusions Surgical removal of upper airway obstruction caused by enlargement of tonsil and adenoid is one of the most effective treatment for pediatric OSAHS. Fibrous endoscopy and cephalometric analysis are helpful to confirm surgical indication. The advantages of transoral endoscopy directed adenoidectomy are as follows: clear and direct visualization, complete removal, without damaging of the peripheral structures.

关 键 词：儿童 阻塞性睡眠呼吸暂停低通气综合征 治疗 增殖腺切除术 扁桃体切除术 

分 类 号：R766[医药卫生—耳鼻咽喉科]