阻塞性睡眠呼吸暂停低通气综合征儿童不同治疗方法的临床疗效评估

A comparative study on efficiency of different therapeutics methods used for obstructive sleep apnea hypopnea syndrome in children

目的 评估阻塞性睡眠呼吸暂停低通气综合征（OSAHS）儿童不同治疗方法的临床疗效,探讨儿童OSAHS有效、科学、费用合理的治疗方案.方法 采用前瞻性随机数字表法,分析2008年3月至2010年12月温州育英儿童医院确诊的OSAHS儿童.分组：轻度OSAHS分为白三烯受体拮抗剂（LTRAs）治疗（MM）组32例、手术治疗（MAT）组28例,中、重度OSAHS也分为LTRAs治疗（SM）组22例、手术治疗（SAT）组36例.MM组、SM组行口服LTRAs治疗6个月,MAT组、SAT组行手术治疗.对各组儿童治疗前和治疗6个月的多导睡眠监测仪（PSG）监测结果、生活质量调查表（OSA-18）评分进行比较分析.对两种治疗方法进行经济学比较、疗效评定,并对手术并发症、术后未缓解原因进行分析.结果 （1）PSG监测：MM组治疗前呼吸暂停低通气指数（AHI,4.56±1.26）明显低于治疗后（3.48±1.52,t =3.50,P＜0.05）;MM组和MAT组氧减指数（ODI,MM组2.18±2.19,MAT组1.80±2.34）、最低血氧饱和度（LSaO2,MM组91.66±2.34,MAT组92.79±2.18）治疗后比较无统计学意义（ODI,=0.65,LSaO2汪-1.93,P＞0.05）;（2）OSA-18评分：MM组睡眠障碍（治疗前14.81 ±6.28,治疗后10.56±3.57）、对监护人影响（治疗前13.56±3.54,治疗后8.97±2.96）、OSA-18总分（治疗前52.66±1.11,治疗后42.56±6.48）治疗前后比较差异有统计学意义（睡眠障碍Z=-3.14,对监护人影响Z=-4.50,OSA-1 8总分Z=-4.01,P＜0.05）;（3）经济学分析：手术治疗除药品费用外,其他经济负担明显高于LTRAs治疗组;（4）疗效评定：各组总有效（治愈＋显效＋有效）分别为：MM组28例（88％）、MAT组28例（100％）、SM组2例（9％）、SAT组35例（97％）.手术治疗组中MAT组有效3例（11％）,SAT组有效7例（19％）,无效1例（3％）,其中9例合并鼻部疾病.结论 中、重度OSAHS儿童首选手术治疗,合并鼻部疾病联合药物治疗.轻度OSAHS儿童可行LTRAs治疗,症状未改善者择期手术治疗.

Objective To evaluate effectiveness therapeutic regimens for obstructive sleep apnea hypopnea syndrome （OSAHS） children at an acceptable cost.Method This study was performed at Yuying Children＆#39;s Hospital of Wenzhou Medical University from Mar.2008 to Dec.2010.Prospective random number table method was used for the analysis; 60 children with mild OSAHS were divided into Mild OSAHS Montelukast Treatment （MM） group and Mild OSAHS Adenotonsillectomy Treatment （MAT） group.32 children in MM group were treated with leukotriene receptor antagonists （LTRAs）,while 28 children in MAT group were treated with adenotonsillectomy.Also,58 children with moderate and severe OSAHS were divided into severe OSAHS Montelukast Treatment （SM） group and severe OSAHS Adenotonsillectomy Treatmen （SAT） group.Twenty-two children in SM group were treated with LTRAs,while 36 children in SAT group were treated with adenotonsillectomy.All selected children were evaluated by polysomnography （PSG） and Obstructive Sleep Apnea-18 （OSA-18） items before and after a six-month treatment.Both records were taken and analyzed,surgical complications and the reason for non-remission after operation were also analyzed.Two therapies were compared based on economic consideration and therapeutic effect.Result （1） PSG：A significant change of a significant change of Apnea Hypopnea Index （AHI） was observed in MM group after the treatment （before receiving the treatment 4.56 ± 1.26,and after receiving the treatment 3.48 ± 1.52,t =3.50,P 〈 0.05）.But for oxygen desaturation Index （ODI） （MM group 2.18 ± 2.19,and MAT group 1.80 ± 2.34） and Lowest Oxygen saturation （LSaO2） （MM group 91.66 ± 2.34,and MAT group 92.79 ±2.18）,there was no significant difference in MM group and MAT group after the treatment （ODI,t =0.65,and LSaO2 t =-1.93,P 〉0.05）.（2） OSA-18 scores：Significant differences were found in sleeping disorder （before 14.81 ± 6.28,and after 10.56 ± 3.57）,the degree of familial stress （before 13.56 ± 3.54,and after 8.97 ± 2.96）,and OSA-18 total scores （before 52.66 ± 1.11,and after 42.56 ± 6.48） in MM group after the treatment（sleeping disorder Z =-3.14,the degree of familial stress Z =-4.50,and OSA-18 total scores Z =-4.01,P 〈 0.05）.（3） In addition to the cost of drugs,groups with surgical treatment had a larger economic burden than those with LTRAs treatment.（4） Treatment was totally effective for 28 children （88%） in MM group,and 28 children （100%） in MAT group.Meanwhile,treatment also achieved an obvious effect on 2 children （9%） in SM group,and in 35 children （97%） in SAT group.In MAT group,3 children improved （11%）.And in SAT group,7 children improved （19%）,but treatment was found to be ineffective in 1 case （3%）.Among those effective and ineffective cases in groups with surgical treatment,there were 9 children with nasal diseases.Conclusion （1） Surgical treatment is recommended as the first choice for children with moderate and severe OSAHS.And for those who also suffer from nasal diseases,treatment combining drugs with surgery is necessary.（2） LTRAs therapy has a good effect for mild OSAHS.Surgery is also recommended when drugs could not achieve any obvious improvement in clinical symptoms of children with mild OSAHS.