不伴鼻疾病的儿童阻塞性睡眠呼吸暂停低通气综合征治疗方法探讨  

Therapeutics Regimen for Treating Obstructive Sleep Apnea-Hypopnea Syndrome in Children without Nasal Diseases

作　　者：俞晨艺[1] 王淼[1] 倪丽艳[1] 

机构地区：[1]温州医科大学附属第二医院育英儿童医院,浙江温州325027

出　　处：《儿科药学杂志》2016年第9期7-10,共4页Journal of Pediatric Pharmacy

摘　　要：目的:探讨不伴鼻疾病的儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的有效治疗方案。方法:采用前瞻性研究方法,选取2008年3月至2014年10月资料完整的OSAHS患儿200例,排除中途退出或失访患儿6例,按随机数字表法分为轻度药物治疗组(A组)47例、轻度手术治疗组(B组)49例、中重度药物治疗组(C组)48例、中重度手术治疗组(D组)50例。A组和C组给予鼻内糖皮质激素(INCS)联合口服白三烯受体拮抗剂(LTRAs)治疗3个月,B组和D组给予手术治疗,比较分析患儿治疗前后多导睡眠监测仪(PSG)监测结果、儿童OSAHS生活质量调查表(OSA-18)评分并评价疗效。结果:治疗后,B组患儿总有效率100%,高于A组的76.60%(P<0.01),D组患儿总有效率98.00%,高于C组的22.92%(P<0.01)。A组治疗后呼吸暂停低通气指数(AHI)、睡眠障碍评分、监护人受影响评分、OSA-18总分均低于治疗前(P均<0.05),氧减指数(ODI)、最低血氧饱和度(LSa O2)、情绪不佳评分、白天生活受影响评分与B组比较差异均无统计学意义(P均>0.05)。C组治疗前后各项PSG监测指标、OSA-18评分比较差异均无统计学意义(P均>0.05)。D组治疗前后各项PSG监测指标、OSA总分、睡眠障碍评分、身体不适症状评分、监护人受影响评分比较差异均有统计学意义(P均<0.05)。结论:不伴鼻疾病的OSAHS轻度患儿可给予INCS+LTRAs治疗,中重度患儿童首选手术治疗。Objective： To investigate the effective therapeutic regimen for obstructive sleep apnea-hypopnea syndrome（ OSAHS）children without nasal diseases. Methods： This study was performed at Yuying Children＇s Hospital of Wenzhou Medical University from March 2008 to October 2014. Prospective random number table method was used for the analysis. Ninety six children with mild OSAHS were divided into group A and group B. Forty seven children in group A were treated by intranasal corticosteroids（ INCS） and leukotrienes receptor antagonist（ LTRAs）,while 49 children in group B were treated by adenotonsillectomy. Also,98 children with moderate and severe OSAHS were divided into group C and group D. Forty eight children in group C were treated by INCS and LTRAs,while 50 children in group D were treated by adenotonsillectomy. All children were evaluated by PSG and OSA- 18 before and after a three-month＇s treatment. Both records were taken and analyzed. Generally,we compared two therapies therapeutic effects. Results：Treatments were totally effective for 36 children（ 76. 60%） in group A,and 49 children（ 100%） in group B,and 11 children（ 22. 92%） in group C,and 49 children（ 98.00%） in group D. AHI,sleeping dysfunction score,guardian affected score,OSA-18 total scores in group A were lower after the treatment（ P0.05）. There were no significant difference in ODI and LSa O2 in group A and group B after the treatment（ P0.05）. There were no significant difference in all the indexes in group C and the differences were significant in group D of all the indexes. Conclusion： INCS combined with LTRAs is a viable therapeutics regimen for mild OSAHS. Surgical treatment is recommended as the first choice for children with moderate and severe OSAHS.

关 键 词：阻塞性睡眠呼吸暂停 儿童 扁桃体切除术 鼻内糖皮质激素 白三烯受体拮抗剂 

分 类 号：R725.6[医药卫生—儿科]