幼儿重度OSAHS的分步治疗  

Stepwise Treatment of Severe Obstructive Sleep Apnea-hypopnea Syndrome in Children

作　　者：郭苏婷 郝丽娟[2] GUO Suting;HAO Lijuan(Qinghai University,Xi′ning 810000,China;Qinghai Red Cross Hospital,Xi′ning 810000,China)

机构地区：[1]青海大学,西宁810000 [2]青海红十字医院,西宁810000

出　　处：《世界睡眠医学杂志》2022年第1期92-96,共5页World Journal of Sleep Medicine

摘　　要：目的:探讨幼儿重度阻塞性睡眠呼吸暂停低通气综合征(Obstructive Sleep Apnea-hypopnea Syndrome,OSAHS)的治疗方案的选择。方法:回顾性分析2020年3月至2020年7月青海红十字医院睡眠医学科收治的3例重度OSAHS患儿(2.5~3.5岁)的阶梯型临床治疗方法并复习相关文献。3名患儿均经PSG确诊为重度OSAHS,药物治疗14~30 d后,患儿症状略好转,但仍有打鼾、憋气憋醒、情绪改变等症状,遂收住院给予无创通气治疗11~14 d。2例择期采用了低温等离子双侧扁桃体切除+腺样体消融手术。结果:患儿1、患儿2手术后1周行睡眠筛查仪复查,患儿1:AHI:5.69(治疗前AHI:90.9),LSO_(2):70%(治疗前LSO_(2):40%);患儿2:AHI:5.4(治疗前AHI:14.2),LSO_(2):86%(治疗前LSO_(2):71%);患儿3行呼吸机治疗后AHI:28.3(治疗前AHI:66.7),LSO_(2):75%(治疗前LSO_(2):71%)。结论:OSAHS患儿的药物、无创通气、手术分步治疗是提高儿童OSAHS安全性、治愈率的重要方法,伴扁桃体腺样体肥大的OSAHS患儿,手术是一线治疗方案,但重度OSAHS患儿手术风险大,并发症出现率高,手术前给予持续正压通气治疗在患儿AHI及缺氧好转后再行手术治疗,可有效的减少围手术期并发症的发生,保证患儿获得最大的治疗效果。因此重度尤其低龄OSAHS患儿药物治疗效果不明显且伴随缺氧明显的情况下无创通气作为中间治疗必不可少。Objective:To explore the stepwise treatment of severe obstructive sleep apnea-hypopnea syndrome(OSAHS)in children.Methods:Three cases of severe OSAHS(2.5-3.5 years old)treated in Sleep Medicine Department of Qinghai Red Cross Hospital from March 2020 to July 2020 were retrospectively analyzed and relevant literatures were reviewed.Three children were diagnosed as severe OSAHS by PSG.After 14-30 days of medication,the symptoms of the patients were slightly improved,but they still had snoring,breath-holding and mood changes,etc.,so they were hospitalized and given non-invasive ventilation treatment for 11-14 days.Low temperature plasma tonsillectomy and adenoid ablation were performed in 2 patients.Results:Two cases underwent sleep screening examination 1 week after surgery,Case 1 AHI was 5.69(AHI:90.9 before treatment),LSO_(2):70%(LSO_(2):40%before treatment);Case 2 AHI:5.4(AHI:14.2 before treatment),LSO_(2):86%(LSO_(2):71%before treatment);The AHI of Case 3 after ventilator treatment was 28.3(AHI before treatment:66.7)and LSO_(2):75%(LSO_(2):71%before treatment).Conclusion:The step-by-step treatment of children with OSAHS including medication,non-invasive ventilation and surgery is an important method to improve the safety and cure rate of children with OSAHS.Surgery is the first-line treatment for children with OSAHS accompanied by tonsil adenoid hypertrophy,and children with severe OSAHS have a high risk of surgery and a high incidence of complications.Continuous positive pressure ventilation before surgery after the improvement of AHI and hypoxia can effectively reduce the incidence of perioperative complications and ensure the maximum therapeutic effect.Therefore,non-invasive ventilation is indispensable for the treatment of severe OSAHS,especially in the case of insignificant medication effect and obvious hypoxia in the young children.

关 键 词：儿童 重度阻塞性睡眠呼吸暂停低通气综合征 分步治疗 

分 类 号：R729[医药卫生—儿科]