中国当代儿科杂志
中國噹代兒科雜誌
중국당대인과잡지
CHINA JOURNAL OF CONTEMPORARY PEDIATRICS
2006年
1期
1-5
,共5页
阻塞性睡眠呼吸暂停/低通气综合征%扁桃体、腺样体切除术%儿童
阻塞性睡眠呼吸暫停/低通氣綜閤徵%扁桃體、腺樣體切除術%兒童
조새성수면호흡잠정/저통기종합정%편도체、선양체절제술%인동
Obstructive sleep apnea/hypopnea syndrome%Tonsillectomy and adenoidectomy%Child
目的评价扁桃体、腺样体切除术对伴有其他上气道疾病的儿童阻塞性睡眠呼吸暂停/低通气综合征(OSAHS)的疗效.方法回顾性总结香港大学附属根德夫人儿童医院睡眠中心1999年5月至2003年5月的儿童OSAHS病例资料.依据睡眠监测结果诊断OSAHS,再根据体格检查及鼻咽侧位片结果确定这些OSAHS患儿是否存在扁桃体、腺样体肥大.将有扁桃体、腺样体肥大的OSAHS患儿分成手术治疗组和对照组,两组随访观察12个月.对术后仍有OSAHS表现的病例行睡眠内窥镜检查寻找原因.结果88例儿童中,61例诊断为OSAHS,其中39例伴有扁桃体、腺样体肥大,25例接受扁桃体、腺样体切除术治疗.在接受手术治疗的患儿中,手 术后随访时氧减指数及最低血氧饱和度较手术前得到显著改善.治疗组中24%随访时仍有OSAHS的表现,而对照组85%的患儿OSAHS表现仍持续存在(OR=15.4,95%置信区间为2.7～87.5).手术后仍有OSAHS表现的主要原因是肥胖、骨软骨发育不良、上气道解剖结构异常以及维持气道开放的神经肌肉功能异常.结论扁桃体、腺样体切除术在扁桃体、腺样体肥大同时伴有其它上气道疾病的大部分亚洲OSAHS儿童中是有效的.由于上气道结构或维持气道开放的神经肌肉功能异常,可以导致手术后OSAHS症状的残存.对这些患儿,需要做进一步检查明确病因.
目的評價扁桃體、腺樣體切除術對伴有其他上氣道疾病的兒童阻塞性睡眠呼吸暫停/低通氣綜閤徵(OSAHS)的療效.方法迴顧性總結香港大學附屬根德伕人兒童醫院睡眠中心1999年5月至2003年5月的兒童OSAHS病例資料.依據睡眠鑑測結果診斷OSAHS,再根據體格檢查及鼻嚥側位片結果確定這些OSAHS患兒是否存在扁桃體、腺樣體肥大.將有扁桃體、腺樣體肥大的OSAHS患兒分成手術治療組和對照組,兩組隨訪觀察12箇月.對術後仍有OSAHS錶現的病例行睡眠內窺鏡檢查尋找原因.結果88例兒童中,61例診斷為OSAHS,其中39例伴有扁桃體、腺樣體肥大,25例接受扁桃體、腺樣體切除術治療.在接受手術治療的患兒中,手 術後隨訪時氧減指數及最低血氧飽和度較手術前得到顯著改善.治療組中24%隨訪時仍有OSAHS的錶現,而對照組85%的患兒OSAHS錶現仍持續存在(OR=15.4,95%置信區間為2.7～87.5).手術後仍有OSAHS錶現的主要原因是肥胖、骨軟骨髮育不良、上氣道解剖結構異常以及維持氣道開放的神經肌肉功能異常.結論扁桃體、腺樣體切除術在扁桃體、腺樣體肥大同時伴有其它上氣道疾病的大部分亞洲OSAHS兒童中是有效的.由于上氣道結構或維持氣道開放的神經肌肉功能異常,可以導緻手術後OSAHS癥狀的殘存.對這些患兒,需要做進一步檢查明確病因.
목적평개편도체、선양체절제술대반유기타상기도질병적인동조새성수면호흡잠정/저통기종합정(OSAHS)적료효.방법회고성총결향항대학부속근덕부인인동의원수면중심1999년5월지2003년5월적인동OSAHS병례자료.의거수면감측결과진단OSAHS,재근거체격검사급비인측위편결과학정저사OSAHS환인시부존재편도체、선양체비대.장유편도체、선양체비대적OSAHS환인분성수술치료조화대조조,량조수방관찰12개월.대술후잉유OSAHS표현적병례행수면내규경검사심조원인.결과88례인동중,61례진단위OSAHS,기중39례반유편도체、선양체비대,25례접수편도체、선양체절제술치료.재접수수술치료적환인중,수 술후수방시양감지수급최저혈양포화도교수술전득도현저개선.치료조중24%수방시잉유OSAHS적표현,이대조조85%적환인OSAHS표현잉지속존재(OR=15.4,95%치신구간위2.7～87.5).수술후잉유OSAHS표현적주요원인시비반、골연골발육불량、상기도해부결구이상이급유지기도개방적신경기육공능이상.결론편도체、선양체절제술재편도체、선양체비대동시반유기타상기도질병적대부분아주OSAHS인동중시유효적.유우상기도결구혹유지기도개방적신경기육공능이상,가이도치수술후OSAHS증상적잔존.대저사환인,수요주진일보검사명학병인.
Objective To evaluate the efficacy of tonsillectomy and adenoidectomy (T&A) in Asian childhood obstructive sleep apnea/hypopnea syndrome (OSAHS). Methods The medical data of the OSAHS patients in the Sleep Center of the Duchess Kent Children's Habilitation Institute from May 1999 to May 2003 were retrospectively reviewed.OSAHS was diagnosed according to the abnormal sleep monitoring results. The clinical outcomes were followed up and compared between the Operation and Non-operation groups (Control) in OSAHS children with adenotonsillar hypertrophy (ATH). Sleep endoscopy was performed for those who had residual OSAHS for the purpose of detecting the underlying causes. Results Sixty-one patients were diagnosed with OSAHS. Among the OSAHS patients, 39 were associated with ATH, and 25 of the 39 patients underwent T&A. The desaturation dip rate and minimum saturation in the Operation group were significantly improved after T&A. Six out of 25 (24%) patients in the Operation group had residual OSAHS whereas 11 out of the 13 (85%) patients in the Control group had unchanged or worsening clinical symptoms (OR = 15.4, 95%CI 2.7- 87.5 ). Residual OSAHS after surgery were attributable to obesity, achondroplasia, upper airway structure anomaly and airway dynamic problems. Conclusions T&A was effective in the majority of Asian childhood OSAHS associated with ATH. Upper airway structure or dynamic abnormalities can result in residual OSAHS in parts of children. Further investigation is required to detect the underlying problems.
