儿童阻塞性睡眠呼吸暂停低通气综合征外科治疗效果欠佳病例的分析

Analysis of poor-responding sleep apnea children to adenoidtonsillectomy and further treatment

目的探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopneasyndrome,OSAHS)儿童外科治疗后效果欠佳的原因及继续治疗方法。方法回顾分析2004年6月—2006年6月在首都医科大学附属北京儿童医院耳鼻咽喉科诊断为 OSAHS 并通过腺样体和(或)扁桃体切除术治疗,且随访资料完整的243例患儿资料,其中男177例,女66例;年龄1岁5个月～14岁。所有患儿术前和术后3个月～12个月采用多道睡眠监测,根据临床症状缓解程度、呼吸暂停低通气指数和最低血氧饱和度评定手术效果。结果痊愈患儿221例(90.9%);22例患儿术后 AHI>5.0次/h,其中5例(2.1%)症状较术前明显好转,17例(7.0%)患儿临床症状无明显缓解。17例疗效不佳患儿中2例为单纯行腺样体切除而有扁桃体肥大者,再次手术切除扁桃体后痊愈;7例并发鼻部疾病(7/47)经药物治疗后好转;并发肥胖(5例)、漏斗胸(1例)、脑瘫(1例)、圆枕增生(1例),使用呼吸机治疗,症状均得到明显缓解。结论手术切除腺样体和(或)扁桃体是治疗儿童 OSAHS 的首选方法。手术效果欠佳主要由于肥胖、鼻部疾病等其他并发症的影响,也有单纯腺样体切除术适应证选择不当造成。对于手术效果不好的患儿要仔细分析原因,注意并发症的治疗,可进一步提高疗效。

Objective To analyze factors on sleep apnea children＇s poor responding to adenoidtonsillectomy, and discuss the further treatment. Methods Two hundred and forty three obstructive sleep apnea hypopnea syndrome （OSAHS） children who had adenoidtonsillectomy or adenoidectomy were reviewed, all cases had follow-up sleep study （polysomnogram, PSG） after surgery. Results According to the results obtained in 3 to 12 months after surgery with PSG, 221 cases （ 90. 9% ） were cured （ apnea and hypopnea index, AHI, 〈 5/h, ） while the remaining 22 cases AHI 〉 5. 0/h. In the latter group, 2 cases who only had adenoidectomy received tonsillectomy afterwards, 7 cases who have nasal congestion were treated with medication, 5 overweight cases and 3 cases with cerebral palsy, pectus excavatum or hyperplastic toil were treated with CPAP. Conclusions Adnoidtonsillectomy is effective for OSAHS children. For the poor responding cases, suitable treatment should be selected accordingly.