手术治疗腺样体肥大儿童阻塞性睡眠呼吸暂停综合征

Adenotonsillectomy or adenoidectomy in the treatment of obstructive sleep apnea in children with adenoidal hypertrophy

摘要:

目的 探讨腺样体切除术、腺样体扁桃体切除术对腺样体肥大儿童阻塞性睡眠呼吸暂停综合征(OSAS)的治疗作用。方法 对 2 0例腺样体肥大合并OSAS(OSAS组 )儿童手术前后的临床表现、多导睡眠图(PSG)检查结果进行前瞻性比较研究 ,并与同期住院的 1 0例单纯性腺样体肥大儿童 (对照组 )进行对照研究。结果 OSAS组的常见症状发生率与对照组差异无显著性 (P >0 .0 5 ) ;两组体块指数分别为 1 5 .4± 2 .5kg/m2 和1 7.6± 3.1kg/m2 ,差异无显著性 (P >0 .0 5 )。OSAS组与对照组的鼻咽侧位片A/n值、总睡眠时间、睡眠效率及S1、S2、慢波睡眠 (SWS)、快速眼动睡眠期 (REM)所占比例差异均无显著性 (P >0 .0 5 )。OSAS患儿术后呼吸暂停指数 (AI)、呼吸暂停低通气指数 (AHI)、阻塞性呼吸暂停指数 (OAI)较术前降低 (P <0 .0 5或 0 .0 1 ) ,REM所占比例较术前增高 (P <0 .0 5 )。结论 腺样体肥大合并OSAS的临床表现、鼻咽侧位片A/n值、睡眠结构与单纯腺样体肥大患儿无差别 ;腺样体肥大合并OSAS儿童手术治疗效果良好。

Abstract:

Objective To investigate the effect of adenotonsillectomy or adenoidectomy in the treatment of obstructive sleep apnea syndrome (OSAS) in children with adenoidal hypertrophy. Methods The clinical menifestations and overnight polysomnography findings in 20 children with OSAS secondary to adenoidal hypertrophy (OSAS group) were compared before and after adenotonsillectomy or adenoidectomy and were compared with those in 10 children with adenoidal hypertrophy without OSAS (Control group) admitted to Beijing Children's Hospital at the same period as the OSAS group. Results There was no significant difference in the incidence of the common symptoms between the OSAS group and the Control group. The body mass index, A/n ratio in the neck roentgenography, total sleep time, sleep efficiency, and the proportion of S1, S2 and slow wave sleep (SWS) time and rapid eye movement (REM) time of the OSAS group did not differ from those of the Control group. After adenotonsillectomy or adenoidectomy, the apnea index, apnea hypopnea index of all children with OSAS and obstructive apnea index significantly decreased and the proportion of REM sleep time in the total sleep time significantly increased (P< 0.05 or 0.01 ). Conclusions There are no differences in clinical manifestations, A/n ratio and the sleep architecture between the adenoidal hypertrophy children with and without OSAS. Adenotonsillectomy or adenoidectomy is effective in the treatment of childhood adenoidal hypertrophy with OSAS.