儿童阻塞性睡眠呼吸暂停低通气综合征的诊治  

Diagnosis and treatment of obstructive sleep apnea hypopnea syndrome in children

作　　者：张亚梅[1] 赵靖[1] 刘卫一[1] 安嘉清[1] 

机构地区：[1]首都医科大学附属北京儿童医院耳鼻咽喉科,北京100045

出　　处：《中华耳鼻咽喉科杂志》2004年第11期654-657,共4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 (obstructivesleepapneahypopneasyndrome ,OSAHS)的诊断和治疗方法。方法　回顾性分析经鼻咽侧位X线摄片、纤维鼻咽镜检查及多道睡眠监测 (polysomnography ,PSG)确诊为OSAHS的 2 85例患儿的临床症状和体征的特点。睡眠呼吸低通气指数 (apneahyponeaindex ,AHI)≥ 5次 /h ,伴随血氧饱和度降低 0 0 3以上的患儿诊断为OSAHS。对其中腺样体、扁桃体肥大的患儿 2 5 5例进行了手术治疗 ,9例使用了持续正压通气治疗(continuouspositiveairwaypressure ,CPAP) ,评价其疗效。结果　OSAHS患儿的主要症状是入睡打鼾、张口呼吸、呼吸暂停、听力下降。 2 85例患儿中腺样体和 (或 )扁桃体肥大 2 81例。手术治疗 2 5 5例 ,其中 2 0 5例行腺样体和扁桃体切除术 ,4 7例行腺样体切除术 ,3例行单纯扁桃体切除术。术后 2 4 8例患儿临床症状明显缓解 ,占 97 2 %。术后 1～ 3个月内 ,对 10 5例患儿复查PSG :AHI、夜间血氧饱和度低于 0 90的时间所占睡眠时间的百分比、最长呼吸暂停时间较术前有明显改善。 9例使用CPAP治疗 ,效果均良好 ,其中 7例为腺样体、扁桃体手术前、后的患儿 ,2例为肥胖低通气患儿。结论　儿童OSAHS有其自身特点 ,PSG是诊断的依据 ,腺样体和扁桃体切除?Objective To discuss the methods of diagnosis and treatment of obstructive sleep apnea hyp opnea syndrome (OSAHS) in children. Methods 285 patients diagnosed OSAHS by X-ray for lateral rhinopharyngeal view, fibrorh inopharyngescopy and overnight polysomnography (PSG) were reviewed retrospective ly the clinical symptoms and signs. The patients whose apnea hyponea index(AHI) ≥5/h, blood oxygen′s saturation reducing over 0.03 are diagnosed as OSAHS. 2 55/285 cases were performed adenoidectomy and/or tonsillectomy and 9 cases were treated with continuous positive airway pressure(CPAP). Results The major symptoms of patients with OSAHS are snoring in sleep, breathing openi ng mouth, apnea, hearing loss. 281/285 cases were diagnosed as adenoid and(or) tonsil hypotrophy. Two hundred- fifty five cases received surgery, adenoidecto my and tonsillectomy in 205,only adenoidectomy in 47, simple tonsillectomy in 3. The clinical symptoms of 248 cases improved evidently after operations. Imp roved rate is 97.2%. In 1～3 months after surgery,PSG were checked in 105 pat ients again: AHI, the percentage of the sleep time for saturation monitored by p ulse oximetry <0.90, the longest time of apnea are improved than pre-operatio n.9 cases using CPAP received good effects, 7 of 9 cases used CPAP were in p re- and /or post- surgery. Two cases were obesity hypopnea syndrome. Conclusions Children with OSAHS has signification themsel f ; PSG is the major means for diagnosing. Surgery is main method for treating ;CPAP can be as the method of treating for serious OSAHS in preoperative prepara tion and postoperative management.

关 键 词：OSAHS 腺样体 患儿 诊断 CPAP 治疗 阻塞性睡眠呼吸暂停低通气综合征 结论 特点 方法 

分 类 号：R766[医药卫生—耳鼻咽喉科] R722[医药卫生—临床医学]