儿童OSAHS与腺样体和扁桃体大小的关系探讨  

The relationship between obstructive sleep apnea hypopnea syndrome and adenoid size as well as tonsil size in Children

作　　者：沈翎[1] 林宗通[1] 许杨杨[1] 杨中婕[1] 

机构地区：[1]福建省福州儿童医院(福建医科大学教学医院)耳鼻咽喉科,福州350005

出　　处：《临床耳鼻咽喉头颈外科杂志》2014年第6期381-385,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：福州市科技计划项目(No:2010-S-80)

摘　　要：目的:探讨儿童OSAHS与腺样体、扁桃体大小的关系。方法:2008-06-2010-10期间在我科门诊和病房以PSG确诊的338例OSAHS患儿为病例组,并根据阻塞性呼吸暂停指数(OAI)或AHI分为轻、中、重3个亚组,同时采用简单随机抽样方法,选择同期就诊的无上呼吸道阻塞症状的207例声带小结患儿为对照组。对2组患儿口咽部、电子鼻咽喉镜的检查结果,进行回顾性分析,探讨腺样体、扁桃体大小与儿童OSAHS的相关性。以SPSS 17.0软件对数据进行统计学分析。结果:病例组Ⅲ、Ⅳ度腺样体以及Ⅲ、Ⅳ度扁桃体的比例分别为89.7%、68.4%,明显高于对照组的30.9%、13.5%,差异有统计学意义(均P<0.01)。病例组中,Ⅳ度与Ⅲ度腺样体比较,Ⅳ度与Ⅲ度扁桃体比较,前者发生OSAHS的危险程度明显增高。腺样体、扁桃体分度的比例在病例组轻、中、重亚组中逐级递增(P<0.01)。采用张口压舌法与电子鼻咽喉镜检查,对多数病例组患儿扁桃体大小和咽腔狭窄的判断结果一致。但35例张口压舌法检查为Ⅰ、Ⅱ度的扁桃体,其中13例(37.1%)以电子鼻咽喉镜检查扁桃体为Ⅲ度。结论:腺样体肥大、扁桃体肥大是儿童OSAHS的危险因素,其中Ⅳ度腺样体和Ⅳ扁桃体的发病风险明显增高;腺样体、扁桃体大小与儿童OSAHS的病情严重程度呈正相关;电子鼻咽喉镜检查是儿童OSAHS病因诊断的重要检查手段,且有助于包埋型扁桃体大小的判断。Objective： To investigate the relationship between obstructive sleep apnea hypopnea syndrome （OSAHS） and adenoid size as well as tonsil size in Children. Method..A total of 545 patients, 338 OSAHS patients （treated group） diagnosed by PSG and 207 patients with vocal cord nodules but symptoms of upper airway obstruction （control group）, were enrolled from inpatient and outpatient between June, 2008 and October, 2010. The oropharynx and electron-nasopharyngolaryngoscopy examination records of the two groups were retrospectively analyzed. The patients in the treated group were also divided into mild group, moderate group and severe group according to obstructive apnea index （OAI） or AHI. SPSS 17.0 was used for statistical analysis. Result： In the treated group, 89.7% had grade II-ivadenoid and 68.4% had grade III-IV tonsil, compared with 30.9% （adenoid） and 13.5% （tonsil） in the control group. The significant differences were found （all P〈0.01）. The comparison between patients with different grades of adenoidal size and tonsil size in the treated group had indicated that patients with grade IV adenoid or grade IV tonsil have a higher risk of OSAHS than patients with grade III adenoid or grade III tonsil. In the treated group, the ratio of patients with different severity of adenoid or tonsil had increased with the severity of OSAHS（P〈0.01）. This retrospective study had also found that most of the grading results from Electron-nasopharyngolaryngoscopy examination were consistent with that from oropharynx examination. 13 （37.1%） of 35 patients with grade I or II tonsil diagnosed by Oropharynx examination were considered as grade III by Electron-nasopharyngolaryngoscopy examination. Conclusion：Adenoidal hypertrophy and tonsil hypertrophy are the risk factors for OSAHS in children. The risk of OSAHS and the severity of OSAHS are positively associated with the severity of adenoid and tonsil. The electron-nasopharyngolaryngoscopy examination is an important examination meth

关 键 词：睡眠呼吸暂停低通气综合征 阻塞性 儿童 腺样体肥大 扁桃体肥大 

分 类 号：R563.8[医药卫生—呼吸系统]