经药物治疗无效的儿童阻塞性睡眠呼吸暂停低通气综合征手术疗效分析  

Effect of surgical treatment of the obstructive sleep apnea hypopnea syndrome in children

作　　者：彭涛 马鹏[1,2] 冯惠琼 李红光[1,2] 李志勇 冯俊[1,2] 黄开来 

机构地区：[1]南充市中心医院耳鼻咽喉科 [2]川北医学院第二临床医学院,四川南充637000

出　　处：《西部医学》2014年第3期355-358,共4页Medical Journal of West China

基　　金：南充市市应用技术研究与开发基金资助(2060402)

摘　　要：目的探讨经药物治疗无效的伴扁桃体或腺样体肥大的儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrom,OSAHS)的手术疗效。方法 124例药物治疗无效、行多导睡眠监测(polysomnography,PSG)诊断为OSAHS并伴扁桃体或腺样体肥大的OSAHS患儿分为单纯扁桃体肥大组、单纯腺样体肥大组和扁桃体伴腺样体肥大组3组,于全麻下行腺样体或扁桃体切除术,并于术后6个月再次通知行PSG监测。比较手术前后睡眠呼吸暂停低通气指数(apnea hypopnea index,AHI)、最低血氧饱和度(lowest oxygen saturation,LSaO2)及临床疗效。结果 124例患儿中91例有术后PSG检查,余33例患儿拒绝行术后PSG检查。经过手术治疗,单纯扁桃体肥大组、单纯腺样体肥大组、扁桃体伴腺样体肥大组平均LSaO2术前分别为(81.7±7.3)%、(82.2±9.1)%和(80.1±8.9)%,术后分别为(93.2%±3.9)%、(93.6±2.7)%和(91.8±4.5)%,组内差异有统计学意义(均P<0.05)。单纯扁桃体肥大组、单纯腺样体肥大组、扁桃体伴腺样体肥大组平均AHI术前分别为(18.4±7.8)、(18.9±8.6)和(22.4±9.5),术后分别为(4.1±1.7)、(5.1±2.4)和(4.9±3.5),组内差异有统计学意义(均P<0.05)。3组间有效率分别为92.1%、90.0%和91.9%,组间差异无统计学意义(P>0.05)。结论对保守治疗无效的伴腺样体或扁桃体肥大的阻塞性睡眠呼吸暂停低通气综合征患儿进行扁桃体或腺样体切除术治疗可明显改善AHI、LSaO2及临床症状。Objective To investigate and analyze the effect of treatment in children with obstructive sleep apnea hypopnea syndrome,which without effect by drug treatment. Methods 124 patients were divided into adenoidal hypertro- phy group, tonsil hypertrophy group,and adenotonsillar hypertrophy group. All the patients used adenoidectomy and or tonsillectomy. All patients received polysomnography check by 6 month postoperative. Result Before surgery, mean lowest oxygen saturation of adenoidal hypertrophy group, tonsil hypertrophy group, and adenotonsillar hypertrophy group were separately 81.7± 7.3%, 82.2± 9.1 %, 80. 1 ± 8.9 %. After surgery, it became to 93.2%±3.9%, 93.6 % ± 2.7 % and 91.8 %± 4.5 %. The difference before and after treatment had statistical significance （P〈 0.05）. Before surgery, mean apnea hypopnea index of adenoidal hypertrophy group, tonsil hypertrophy group,and adenotonsillar hypertrophy group was separately 18.4± 7.8,18.9± 8. 6,22.4 ± 9.5. After surgery, it became to 4. 1± 1.7,5.1± 2.4 and 4.9±3.5. The difference before and after treatment had statistical signifieance（P〈0.05）. The effect of three groups were 92.1 %, 90. 0 % and 91.9% separately（P〉0. 05）. Conclusion Adenoidectomy can improve AHI, LSaO2 and clinical symptoms of obstructive sleep apnea hypopnea syndrome.

关 键 词：腺样体扁桃体切除术 儿童 睡眠呼吸暂停 阻塞性 

分 类 号：R729[医药卫生—儿科]