小儿阻塞性睡眠呼吸暂停综合征的手术疗效分析

The effect of surgery of obstructive sleep apnea syndrome(OSAS) in children

目的探讨手术对小儿阻塞性睡眠呼吸暂停综合征(OSAS)的疗效,观察多导联睡眠监护仪对儿童OSAS的临床应用价值。方法分析60例OSAS患儿临床资料,应用睡眠呼吸监护仪,对60例患儿术前及其中37例扁桃体摘除术加(或)腺样体刮除术后患儿于夜间睡眠时做持续7h以上记录,观察最长呼吸暂停时间、最长低通气时间、呼吸暂停和低通气次数及呼吸紊乱指数、睡眠期最低血氧饱和度等8项指标,并进行比较。结果60例术前均有扁桃体和(或)增殖体肿大,睡眠时伴粗大鼾声、憋气等症状。睡眠监测结果:最长呼吸暂停时间为49(8～182)s;呼吸暂停次数为25(3～236)次;最长低通气时间为30(5～92)s;低通气次数为9(1～92)次;呼吸暂停指数为4.6(0.6～25.8);低通气指数为1.9(0～15);呼吸紊乱指数为6.8(0.5～3.9);最低血氧饱和度75.8%(25%～93%)。手术后:患儿临床症状明显缓解,最长呼吸暂停时间、呼吸暂停总时间、最长低通气时间、低通气总时间较术前明显缩短,呼吸暂停次数、低通气次数明显减少,上述各指数明显下降,最低血氧饱和度为93.5%(65%～98%),与术前比较差异均有显著意义(P<0.01)。结论扁桃体和(或)增殖体大是引起小儿OSAS最主要的病因,手术治疗是目前最主要的治疗方法;确诊可依靠多导睡眠图,它可客观记录数据和图形,可用于治疗效果的判断。

Objective To explore the effect of surgery of obstructive sleep apnea syndrome（OSAS） in children. Methods 60 children with OSAS were reviewed, every patient was monitored with polysomnography（PSG） for 7 hours at night for 8 parameters, including the longest apnea time（LAT）, apnca and hypopnea index（AHI）, the lowest oxygen saturation（Saq）, tonsillectomy and adenoideetomy were performed for 37 cases of OSAS, the parameters obtained before and after operation were analyzed. Results Adenotonsinar hypertrophy and loud snoring during sleep were found in all cases. The mean values of the PSG parameters were as follows： the longest apoea time was 49（8-182） seconds（s）; the time of apnea was25（3-236）, the longest hypopnea time was 30（5-92）s; the time of hypopnea was9（1-92）; the apnea index was 4.6（0.6-25.8）; the hypopnea index was 1.9（0- 15）; the apnea and hypopnea index（AHI） was 6.8（0.5-39）; the lowest saturation of oxygen was 75.8%（25%- 93%）. Compared with preoperation groups there was a staististieally significant difference （P〈0.01）. the lowest oxygen saturation was 93.5%（65%-98%）. Clinically effective rate of the surgeries was over 90%. Conelusions Adenotonsillar hypertrophy seemed to be an important cause of OSAS in children. Surgery is the important mean to cure OSAS. Snoring, spnea, apnea and low ventilation are the major clinical characteristics of OSAS in children. Confirmed diagnosis of the syndrome in children requires PSG reeordings.