中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2013年
3期
213-217
,共5页
王海飞%朱瑾%方瑜%陈鑫%张海生%陆锦莲
王海飛%硃瑾%方瑜%陳鑫%張海生%陸錦蓮
왕해비%주근%방유%진흠%장해생%륙금련
睡眠呼吸暂停,阻塞性%儿童%注意力缺陷障碍伴多动%神经心理学测验
睡眠呼吸暫停,阻塞性%兒童%註意力缺陷障礙伴多動%神經心理學測驗
수면호흡잠정,조새성%인동%주의력결함장애반다동%신경심이학측험
Sleep apnea,obstructive%Child%Attention deficit disorder with hyperactivity%Neuropsychological tests
目的 通过视听整合连续测试(integrated visual and auditory continuous performance test,IVA-CPT)研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对儿童反应控制力、注意力和多动行为的影响.方法 51例经多道睡眠图(PSG)监测确诊为OSAHS的5～12岁患儿行双侧扁桃体+腺样体或单纯腺样体切除术,并在术前、术后3个月、术后6个月3个时间点(下称第1、2、3时间点)行IVA-CPT和PSG检测.按病程分组(分为病程＜5年组和≥5年组),用SPSS19.0软件对检测结果进行统计学分析.结果 两组不同病程患儿术前性别、体质量指数(BMI)、病情严重程度分布均衡,差异无统计学意义(P值均＞ 0.05).51例中3个时间点患儿精神心理行为异常例数分别为32例(62.7％)、25例(49.0％)和8例(15.7％),第1、2时间点间异常率比较差异无统计学意义(x2=1.49,P=0.163)；第2、3时间点间异常例数比较差异有统计学意义(x2=12.95,P＜0.001).重复测量方差分析显示两组患儿综合尺度反应控制商数(full scale response control quotient,FRCQ)、综合尺度注意力商数(tull scale attention quotient,FAQ)和多动商数(hyperactivity,HYP)各时间点平均值均随时间延长逐渐改善,差异均有统计学意义(F值分别为342.15、263.12、380.57,P值均＜0.001)；不同病程组间各时间点比较差异也有统计学意义(F值分别为167.05、126.47、117.683,P值均＜0.001),且FRCQ和HYP在病程＜5年和≥5年两组间分别存在交互作用(P值均＜0.001).不同病程组患儿的呼吸暂停低通气指数(AHI)、最低动脉血氧饱和度(LaSO2)组内各时间点比较,差异均有统计学意义(F值分别为99.057和70.742,P值均＜0.001).不同病程组间各时间点AHI、LaSO2比较,AHI和LaSO2差异均无统计学意义(P＞0.05).AHI和LaSO2不存在病程与时间的交互作用.结论 OSAHS对儿童反应控制力、注意力和多动行为有明显影响,扁桃体、腺样体切除术后逐步恢复.及早治疗可减少OSAHS对儿童精神心理方面的影响.
目的 通過視聽整閤連續測試(integrated visual and auditory continuous performance test,IVA-CPT)研究阻塞性睡眠呼吸暫停低通氣綜閤徵(OSAHS)對兒童反應控製力、註意力和多動行為的影響.方法 51例經多道睡眠圖(PSG)鑑測確診為OSAHS的5～12歲患兒行雙側扁桃體+腺樣體或單純腺樣體切除術,併在術前、術後3箇月、術後6箇月3箇時間點(下稱第1、2、3時間點)行IVA-CPT和PSG檢測.按病程分組(分為病程＜5年組和≥5年組),用SPSS19.0軟件對檢測結果進行統計學分析.結果 兩組不同病程患兒術前性彆、體質量指數(BMI)、病情嚴重程度分佈均衡,差異無統計學意義(P值均＞ 0.05).51例中3箇時間點患兒精神心理行為異常例數分彆為32例(62.7％)、25例(49.0％)和8例(15.7％),第1、2時間點間異常率比較差異無統計學意義(x2=1.49,P=0.163)；第2、3時間點間異常例數比較差異有統計學意義(x2=12.95,P＜0.001).重複測量方差分析顯示兩組患兒綜閤呎度反應控製商數(full scale response control quotient,FRCQ)、綜閤呎度註意力商數(tull scale attention quotient,FAQ)和多動商數(hyperactivity,HYP)各時間點平均值均隨時間延長逐漸改善,差異均有統計學意義(F值分彆為342.15、263.12、380.57,P值均＜0.001)；不同病程組間各時間點比較差異也有統計學意義(F值分彆為167.05、126.47、117.683,P值均＜0.001),且FRCQ和HYP在病程＜5年和≥5年兩組間分彆存在交互作用(P值均＜0.001).不同病程組患兒的呼吸暫停低通氣指數(AHI)、最低動脈血氧飽和度(LaSO2)組內各時間點比較,差異均有統計學意義(F值分彆為99.057和70.742,P值均＜0.001).不同病程組間各時間點AHI、LaSO2比較,AHI和LaSO2差異均無統計學意義(P＞0.05).AHI和LaSO2不存在病程與時間的交互作用.結論 OSAHS對兒童反應控製力、註意力和多動行為有明顯影響,扁桃體、腺樣體切除術後逐步恢複.及早治療可減少OSAHS對兒童精神心理方麵的影響.
목적 통과시은정합련속측시(integrated visual and auditory continuous performance test,IVA-CPT)연구조새성수면호흡잠정저통기종합정(OSAHS)대인동반응공제력、주의력화다동행위적영향.방법 51례경다도수면도(PSG)감측학진위OSAHS적5～12세환인행쌍측편도체+선양체혹단순선양체절제술,병재술전、술후3개월、술후6개월3개시간점(하칭제1、2、3시간점)행IVA-CPT화PSG검측.안병정분조(분위병정＜5년조화≥5년조),용SPSS19.0연건대검측결과진행통계학분석.결과 량조불동병정환인술전성별、체질량지수(BMI)、병정엄중정도분포균형,차이무통계학의의(P치균＞ 0.05).51례중3개시간점환인정신심리행위이상례수분별위32례(62.7％)、25례(49.0％)화8례(15.7％),제1、2시간점간이상솔비교차이무통계학의의(x2=1.49,P=0.163)；제2、3시간점간이상례수비교차이유통계학의의(x2=12.95,P＜0.001).중복측량방차분석현시량조환인종합척도반응공제상수(full scale response control quotient,FRCQ)、종합척도주의력상수(tull scale attention quotient,FAQ)화다동상수(hyperactivity,HYP)각시간점평균치균수시간연장축점개선,차이균유통계학의의(F치분별위342.15、263.12、380.57,P치균＜0.001)；불동병정조간각시간점비교차이야유통계학의의(F치분별위167.05、126.47、117.683,P치균＜0.001),차FRCQ화HYP재병정＜5년화≥5년량조간분별존재교호작용(P치균＜0.001).불동병정조환인적호흡잠정저통기지수(AHI)、최저동맥혈양포화도(LaSO2)조내각시간점비교,차이균유통계학의의(F치분별위99.057화70.742,P치균＜0.001).불동병정조간각시간점AHI、LaSO2비교,AHI화LaSO2차이균무통계학의의(P＞0.05).AHI화LaSO2불존재병정여시간적교호작용.결론 OSAHS대인동반응공제력、주의력화다동행위유명현영향,편도체、선양체절제술후축보회복.급조치료가감소OSAHS대인동정신심리방면적영향.
Objective To study the impact in response control,attention and hyperactivity behavior on children with obstructive sleep apnea hypopnea syndrome (OSAHS) by the integrated visual and auditory continuous performance test (IVA-CPT).Methods Fifty-one children aged between 5 and 12 years were diagnosed as OSAHS by polysomnography (PSG),and received adenotonsillectomy and adenoidectomy or only adenoidectomy.Then received IVA-CPT and PSG before surgery,3 months after surgery and 6 months after surgery (named as first,second and third time point).These children were divided into two groups according to the disease course (group A:course of disease ＜ 5 years ; group B:course of disease ≥ 5years).The SPSS 19.0 was used for statistical analysis.Results By balanced test,there were no differences in gender,body mass index (BMI) and disease severity among the two groups before surgery (P ＞0.05).The numbers of children with abnormal psychological behavior at three time points were 32(62.7％),25(49.0％) and 8(15.7％).The abnormal rate did not show statistical difference between the first and second time point(x2 =1.49,P =0.163),but did show statistical difference between the second and third time point (x2 =12.95,P ＜ 0.001).Repetitive measurement and analysis of variance showed that there were statistical differences in means of FRCQ,FAQ and HYP between three time points in two groups(F were 342.15,263.12,380.57,P＜0.001),and all the means improved with time.It also showed that there were statistical differences in means of FRCQ,FAQ and HYP between two groups at every time point(F were 167.05,126.47,117.683,P ＜0.001).FRCQ and HYP all showed interation effect between two groups (P ＜ 0.001).Means of apnea hypopnea index (AHI) and lowest arterial (LaSO2) were compared between three time points in two groups and all showed statistical differences (F were 99.057,70.742,P ＜ 0.001).Means of AHI and LaSO2 were compared between two groups at every time point.AHI and LaSO2 did not show statistical difference (P ＞ 0.05).AHI and LaSO2 did not exist interation effect of disease course and time.Conclusions OSAHS obviously affect the children's response control,attention and hyperactivity behavior,but can recover gradually after adenotonsillectomy and adenoidectomy or only adenoidectomy.Therefore,Children with OSAHS should receive treatment as early as possible so as to reduce the influence on psychology.
