CAJ | 학술논문

目的了解治疗腺样体、扁桃体肥大所致阻塞性睡眠呼吸暂停低通气综合征(OSA HS)对儿童难治性哮喘的影响.方法入组52例难治性哮喘伴腺样体和/或扁桃体肥大所致OSAHS患儿,根据家长意愿采用手术治疗(低温等离子射频腺样体消融术和/或扁桃体切除术)组32例,保守治疗(鼻喷激素+口服孟鲁司特钠咀嚼片等)组20例.所有患儿均于治疗前后进行哮喘状态评估及多道睡眠图(PSG)监测,并随访6个月.结果所有患儿在治疗3个月后PSG监测值均有改善,手术组患儿的各项数值改善均明显优于保守组,差异均有统计学意义(P值均＜0.05).手术组患儿OSAHS治愈8例,显效16例,有效8例;保守组患儿治愈2例,显效6例,有效9例,无效3例;两组比较差异有统计学意义(x2 =8.91,P=0.031).所有患儿在治疗6个月后各项哮喘状态评估参数均有改善,速效β2激动剂使用次数减少,手术组患儿的各项指标改善均明显优于保守组,差异均有统计学意义(P值均＜0.05).肺功能检测的最大呼气流量日内变异率改善值与PSG监测的呼吸暂停低通气指数及最低动脉血氧饱和度改善值经Pearson相关性分析,r值为0.712和0.726,P值均＜0.01,均呈相关关系.结论对于OSAHS伴难治性哮喘患儿,积极治疗OSAHS可有效改善哮喘症状及减少哮喘缓解药物使用次数,且手术治疗的疗效优于保守治疗.
목적 료해치료선양체、편도체비대소치조새성수면호흡잠정저통기종합정(OSA HS)대인동난치성효천적영향.방법 입조52례난치성효천반선양체화/혹편도체비대소치OSAHS환인,근거가장의원채용수술치료(저온등리자사빈선양체소융술화/혹편도체절제술)조32례,보수치료(비분격소+구복맹로사특납저작편등)조20례.소유환인균우치료전후진행효천상태평고급다도수면도(PSG)감측,병수방6개월.결과 소유환인재치료3개월후PSG감측치균유개선,수술조환인적각항수치개선균명현우우보수조,차이균유통계학의의(P치균＜0.05).수술조환인OSAHS치유8례,현효16례,유효8례;보수조환인치유2례,현효6례,유효9례,무효3례;량조비교차이유통계학의의(x2 =8.91,P=0.031).소유환인재치료6개월후각항효천상태평고삼수균유개선,속효β2격동제사용차수감소,수술조환인적각항지표개선균명현우우보수조,차이균유통계학의의(P치균＜0.05).폐공능검측적최대호기류량일내변이솔개선치여PSG감측적호흡잠정저통기지수급최저동맥혈양포화도개선치경Pearson상관성분석,r치위0.712화0.726,P치균＜0.01,균정상관관계.결론 대우OSAHS반난치성효천환인,적겁치료OSAHS가유효개선효천증상급감소효천완해약물사용차수,차수술치료적료효우우보수치료.
Objective The aim of this study was to understand the effect of different treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) for refractory asthma in children.Methods Fifty two children (32 in surgical group,20 in conservative group) with refractory asthma and OSAHS were included in the study.All children received asthma condition assessment and polysomnography (PSG) examination before and after treatment,and were followed up for 6 months.Results All children got improved in PSG values 3 months after treatment,more significant improvement was achieved in surgical group than in conservative group (P ＜ 0.05).While compared of OSAHS treatment,there were 2 cure,6 notable effective,9 effective,3 in vain cases in conservative group,8 cure,16 notable effective,8 effective,0 in vain cases in surgery group.There was significant difference between the two groups (x2 =8.91,P =0.031).All children got improved in asthma condition evaluation parameters and decreased the use number of short acting β2 agonists after 6 months treatment.More significant improvement was achieved in surgical group than in conservative group.The differences of all the items had statistical significance (P ＜ 0.05).There was statistical correlation between days mutation rate of peak expiratory flow (PEF) and apnea hypopnea index (r =0.712,P ＜ 0.01),and between days mutation rate of PEF and lowest oxygen saturation (r =0.726,P ＜ 0.01).Conclusions Active treatment of OSAHS can improve asthma symptoms and reduce asthma medication effectively.The curative effect of surgical treatment is superior to conservative treatment.