无创通气治疗儿童阻塞性睡眠呼吸障碍  

Application of non -invasive ventilation in children with airway obstructive diseases

作　　者：许志飞[1] 李蓓[2] 张亚梅[2] 申昆玲[1] 

机构地区：[1]首都医科大学附属北京儿童医院呼吸内科,100045 [2]首都医科大学附属北京儿童医院耳鼻咽喉头颈外科,100045

出　　处：《中华实用儿科临床杂志》2015年第4期250-253,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：“十二五”国家科技支撑汁划（2012BA103802）;北京市医院管理局临床医学发展专项经费资助临床技术创新项目（XM201408）

摘　　要：目的 探讨无创通气治疗在儿童呼吸道阻塞性疾病，特别是其在阻塞性睡眠呼吸暂停综合征（OSAS）儿童中的应用。方法 本研究为病例随访研究。对2005年10月至2013年10月在首都医科大学附属北京儿童医院睡眠中心因呼吸道梗阻引起睡眠呼吸暂停综合征或慢性呼吸衰竭需要呼吸机支持的患儿进行病例资料收集并随访。根据患儿情况选择不同模式呼吸机，并进行手工压力滴定。使用呼吸机治疗的同时进行脉搏、血氧饱和度或多导睡眠仪监测。根据病情，部分患儿出院后继续家庭无创通气支持治疗，每3、6或12个月对患儿进行随访。结果 截至2013年10月，共有37例患儿接受无创通气支持治疗。其中男32例，女5例；年龄1岁2个月～12岁6个月。患儿病种包括单纯腺样体、扁桃体肥大的OSAS患儿，同时伴有其他疾病的OSAS患儿，如黏多糖病、精神运动发育迟滞、脑性瘫痪、重度肥胖、闭塞性细支气管炎等。无创通气治疗前后比较，患儿打鼾及呼吸暂停消失，呼吸费力明显减轻，日间精神状态得到改善；实验室相关指标，如呼吸暂停低通气指数（P 〈0.01）、阻塞性呼吸暂停指数（P =0.001）、氧减指数（P =0.001）、最低血氧饱和度（P 〈0.001）等较治疗前明显好转。至随访截点，18例（49%）患儿仍在家中进行无创通气治疗；9例（24%）患儿出院后即中断治疗；4例（11%）患儿呼吸道梗阻的症状消失、实验室检测正常，因而停止治疗；4例（11%）患儿治疗维持3个月，之后失访；2例（5%）患儿因原发病死亡。结论 儿童睡眠呼吸障碍中的一些特殊人群需要呼吸支持，儿童睡眠呼吸障碍患儿中可以有效实施无创通气。Objective To investigate the application of non - invasive ventilation in children with airway obstructive diseases, especially those who had obstructive sleep apnea syndrome （ OSAS ）. Methods A case follow - up study was conducted between October 2005 and October 2013 in children who had airway obstruction that led to OSAS or chronic respiratory failure and had been given non - invasive ventilation therapy. Children received non - invasive ventilation support, and pressure titration was performed manually in the sleep center while the mode was chosen according to their disease condition. Pulse rate, oxygen saturation or polysomnography were monitored during the treatment. Some patients went on receiving ventilation support when discharged home depending on their disease status. Patients were followed up every 3,6, or 12 months. Results Thirty - seven patients received non - invasive ventilation treatment till October 2013. Thirty -two cases were boys,and 5 cases were girls. The age ranged from 1 year old and 2 months to 12 years old and 6 months. The underlying diseases included OSAS with adenotonsillar hypertrophy, OSAS with mucopolysaccharidosis, mental retardation, cerebral palsy, morbid obesity, and bronchiolitis obliterans. All the OSAS patients had their snoring and apneas relieved, and respiratory distress and daytime symptoms were improved. Regarding the sleep study parameter, the apnea hypopnea index （ P 〈 0.001 ） , obstructive apnea index （ P = 0.001 ） , oxygen desaturation index（ P = 0. 001 ） ,minimum oxygen saturation （P 〈 0. 001 ） were improved. Till the end of the study, 18 children （49%）were still receiving non - invasive ventilation, 9 children （24%） stopped ventilation after discharge home ,4 children （ 11% ）ceased treatment as their symptoms disappeared and polysomnography data was normal,4 chil- dren （11% ） lost follow -up 3 months after treatment, and 2 children （5%） died of underlying disease. Conclusions Some children with airway obstruction need

关 键 词：无创通气 儿童 阻塞性睡眠呼吸暂停综合征 呼吸衰竭 

分 类 号：R766[医药卫生—耳鼻咽喉科]