68例儿童阻塞性睡眠呼吸障碍的临床分析

Clinical analysis of 68 patients with obstructive sleep-disordered breathing in children

目的:探讨儿童阻塞性睡眠呼吸障碍(OSDB)的临床特征、诊断方法和治疗特点。方法:总结68例OSDB患儿的术前临床特征、鼻咽侧位片、鼻内镜和46例PSG的特点。结果:术前PSG(46例)AHI0.1～24.0次/h,经扁桃体和(或)腺样体切除术后,术后随访3个月～1.5年,上、中咽气道间隙的狭窄或阻塞明显改善,睡眠时打鼾、张口呼吸和憋气等症状消失56例、明显减轻9例、复发3例,复发的原因是单侧扁桃体代偿性增生,总有效率95.5%。16例26耳行鼓膜置管术后,11例16耳通气管3个月后自行脱落或取出后未再复发。鼻咽侧位片与术前的测量比较鼻咽间隙明显扩大。结论:导致儿童OSDB的主要原因是扁桃体和(或)腺样体肥大引起的上、中咽气道阻塞,其诊断及治疗方法的选择有赖于PSG、鼻咽侧位片、鼻内镜和临床表现综合考虑,年龄非手术的绝对禁忌。全身麻醉下扁桃体剥离和鼻内镜下腺样体吸割术是目前治疗儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)安全、有效的方法。

Objective：To explore the clinical festures and the diagnosis and the treatment of pediatric obstructive sleep-disordered breathing. Method： Sixty- disordered breathing. Method： Sixty eight cases with obstructive sleep-disordered breathing were reviewed including clinical features and cephalometric analysis and endoscopic examination, 46 of all them were study of polysomnography. Result： Forty six cases were examined with polysomnography in preoperative. AHI 0. 1-24.0 times/hour. Follow up 3 months to 1.5 year, 68 patients were performed with adenotonsillectomy, upper airway obstruction caused by adenotonsillar hypertrophy were enlarged remarkably. Fifey-six cases main symptoms （snoring, mouth breathing and apnea） disappeared completely, nine cases were relief, 3 cases were reappear. Eleven cases （16 ears） of secretory otitis media after insert plastic tube into tympanum and 9 cases chronic sinusitis were relief. Conclusion： Upper airway obstruction caused by adenotonsillar hypertrophy were major reasons to lead to pediatric obstructive sleep-disordered breathing. The diagnosis and treatment must be combined clinical features with all kinds of examinations （cephalometric, endoscopic, polysomnography）. Tonsillectomy and/or adenoidectomy with soft-tissue shavers were safe and effective in treatment of OSAHS children.