小儿阻塞性睡眠呼吸暂停低通气综合征的诊断及治疗

Diagnosis and treatment of pediatric of obstructive sleep apnea hypopnea in children in the primary hospital

目的探讨基层医院小儿阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的诊断和治疗。方法对临床疑似患儿,用多功能监测仪行夜间持续脉搏氧饱和度和呼吸监测、头颈侧位摄片、纤维鼻咽镜检查,确诊后行手术治疗。结果患儿多有睡眠粗响鼾声、扁桃体和(或)腺样体肥大,呼吸道感染、中耳炎、发育不良及中枢系统并发症的发生率较高。最低氧饱和度(85±7)%,睡眠呼吸暂停指数(apneaindex,AI)≥1者22例,睡眠呼吸暂停低通气指数(apneahypopneaindex,AHI)≥5者30例。在全麻下行扁桃体和腺样体切除术,同时行改良悬雍垂腭咽成形3例,双侧鼓膜切开引流术15例。术后症状及相关指标改善明显。结论便携式多功能监测仪可精确诊断OSAHS,扁桃体和腺样体切除是有效的治疗方法。

Objective To discuss the methods of diagnosis and treatment of pediatric obstructive sleep apnea hypopnea(OSAHS) in the primary hospital.Methods 30 children suspected OSAHS(28 boy,2 gril) were diagnosis by X-ray nasopharyn lateral view,fibrous endoscopic examination and the continuous monitroing of nocturnal puise oximentry(SpO_2) and breathing.All the patients were treated by operation.Results Most of them had severe snoring,enlargement of tonsil and/or adenoide.There's a high incidence of respiratory infection,otitis media,hypogenesis and the CNS complication.The lowest SpO_2 showed (85±7)%,apnea index(AI)≥1(22 cases),apnea hypopnea index(AHI)≥5(30 cases).They were treated by tonsillectomy and/or adenoidectomy under general anesthesia,3 patients were also operation with UPPP and 15 patients by myringotomy.All patients reported improvement of postoperative syndrom and correlatated factors.There are airway complications in the perioperative period.Conclusion Pediatric OSAHS is easily misdiagnosis in the primary hospital,multifunctional monitor provides an accurate method for the diagnosis of pediatric OSAHS.Tonsillectomy and adenoidectomy are the most effective way of treatment.