儿童阻塞性睡眠呼吸暂停低通气综合征的治疗方法探讨  

Discussion on the treatment methods of pediatric obstructive sleep apnea hypopnea syndrome

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耳鼻咽喉科福建医科大学教学医院,350005

出　　处：《中华耳鼻咽喉头颈外科杂志》2014年第7期574-581,共8页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：基金项目：福州市科技计划项目（2010-S-80）

摘　　要：目的 探讨儿童阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的治疗方法.方法 选取2008年6月至2011年4月临床资料完整的386例OSAHS患儿,将腺样体和扁桃体≤Ⅲ度的90例（A组）分成A1、A2组,腺样体和（或）扁桃体Ⅳ度的296例（B组）中≤3岁的22例纳入B1组,其余274例分为B1、B2、B3组.治疗前及治疗后3和6个月行腺样体、扁桃体大小检查及鼻腔鼻内镜检查（采用Lund-Kennedy评分法）;治疗前和治疗后3个月行多道睡眠图（PSG）监测,评估OSAHS严重程度和疗效.药物治疗包括抗生素、鼻用激素、白三烯拮抗剂和黏液促排剂,保守治疗指药物联合鼻腔分泌物吸引,手术治疗指腺样体和扁桃体切除术.A1组药物治疗3个月;A2和B1组保守治疗3个月;B2组保守治疗3天行手术,术后药物治疗2周;B3组保守治疗2周后手术,术后继续药物治疗,总疗程3个月.结果 治疗3个月后A2组腺样体、扁桃体均缩小（Wald x2值分别为10.584和8.366,P值均＜0.05）,6个月无明显反弹;A1组均无明显缩小（P值均＞0.05）.治疗后A组鼻腔鼻内镜检查评分均下降（F=403.420,P＜0.05）,但6个月后A1组反弹（P＜0.05）,A2组无明显反弹.治疗3个月PSG监测A2组患儿均痊愈,A1组仅43.2％痊愈,差异有统计学意义（x2=36.189,P＜0.05）.B2、B3组患儿腺样体、扁桃体切除后均未见复发,B1组治疗后腺样体、扁桃体大小均无缩小（P值均＞0.05）.治疗后B组鼻腔鼻内镜检查评分均显著下降（F=1 614.244,P＜0.05）,但6个月后B1、B2组均反弹（P值均＜0.05）,B3组无明显反弹.PSG监测B3组患儿均痊愈,B2组73.4％痊愈,B1组仅57.4％痊愈,差异有统计学意义（x2=90.846,P＜0.05）.结论 儿童OSAHS应根据年龄、病情、腺样体、扁桃体大小选择治疗方法.腺样体和扁桃体≤Ⅲ度和年龄小于3岁者,应以保守治疗为主;腺样体和（或）扁桃体Ⅳ度者则应以手术治疗为主,术前保守治疗可降低围手术�Objective To explore the treatment methods of pediatric obstructive sleep apnea hypopnea syndrome （ OSAHS）. Methods A total of 386 children with OSAHS were enrolled from June 2008 to April 2011. Ninety children with adenoid and tonsil ≤degree Ⅲ （group A） were randomly divided into A1 subgroup and A2 subgroup, while 22 of 296 （ group B） children aged less than 3 years old with degree 1V adenoid and（or） tonsil were divided into B1 subgroup, and the other 274 of 296 children with degree IV adenoid and （or） tonsil were divided into B1 subgroup, B2 subgroup and B3 subgroup. The adenoid, tonsil size examination and nasal endoscopic examination scores were performed before treatment, 3 months and 6 months after treatment. Drug therapy included oral antibiotics, mometasone furoate as a nasal spray, leukotriene receptor antagonist （LTRAs）, mucoactive medications. Conservative treatment meant drugtherapy plus negative pressure of sputum aspiration. Surgical treatment meant coblation adenotonsillectomy. A1 subgroup received drug therapy for 3 months; A2 and B1 subgroup received conservative treatment for 3 months; B2 subgroup received coblation adenotonsillectomy after 3 days conservative treatment and postoperative drug therapy for 2 weeks; B3 subgroup received coblation adenotonsillectomy after 2 weeks conservative treatment and postoperative drug therapy for 3 months. Results The adenoid and tonsil size of A2 subgroup decreased at 3 months after treatment （ Wald X2 were 10. 584 and 8. 366,respectively,P 〈0. 05）, no significant re-increase was found at 6 months, and no decrease was found in the A1 subgroup （P 〉 0. 05）. The nasal endoscopic examination scores decreased in both A1 and A2 subgroup at 3 months after the treatment （ F = 403. 420 ,P 〈 0. 05 ）, but it was found re-increase in A1 subgroup at the 6 months （ P 〈 0. 05 ） , no significant re-increase was found in the A2 subgroup. The polysomnography （PSG） monitor of A2 subgroup was 100. 0% normal at 3 months aft

关 键 词：睡眠呼吸暂停 阻塞性 儿童 腺样体切除术 扁桃体切除术 鼻炎 药物疗法 

分 类 号：R766[医药卫生—耳鼻咽喉科]