鼻镜下低温等离子射频消融术对儿童鼾症患者应激反应及通气功能的影响

Effect of nasal endoscopic low temperature plasma radiofrequency ablation on the stress response and ventilation function in children with obstructive sleep apnea-hypopnea syndrome

目的分析鼻镜下低温等离子射频消融术对儿童鼾症患者应激反应及通气功能的影响。方法选取儿童鼾症患者78例，以随机数字表法分为观察组39例和对照组39例。对照组实施腺样体刮除及扁桃体剥离术，观察组实施鼻镜下低温等离子射频消融术。统计两组总有效率，并比较两组手术用时，术中失血量，术后1、3 d视觉模拟评分法（VAS）评分，血清应激反应指标[谷胱甘肽（GSH）、丙二醛（MDA）、超氧化物歧化酶（SOD）、硝基酪氨酸（3-NT）]水平，同时采用多导睡眠图检测两组术前和术后6个月通气功能[血氧饱和度〈90%时间所占睡眠时间百分比（SLT90%）、呼吸紊乱指数（AHI）、最长呼吸暂停时间（LAT）、氧减指数（ODI）]指标水平。结果观察组总有效率为94.87%，高于对照组的76.92%，差异有统计学意义（P〈0.05）。与对照组相比，观察组手术用时，术中失血量，术后1、3 d VAS评分较低，差异有统计学意义（P〈0.05）。观察组GSH、SOD高于对照组，MDA、3-NT低于对照组，差异有统计学意义（P〈0.05）。两组术前SLT90%、AHI、LAT、ODI比较差异未见统计学意义（P〉0.05）；术后6个月，观察组SLT90%、AHI、LAT、ODI均明显低于对照组，差异有统计学意义（P〈0.05）。结论鼻镜下低温等离子射频消融术治疗儿童鼾症可减少术中失血量，缓解患儿术后疼痛与应激反应，并改善患儿的通气功能。

Objective To analyze the therapatic effect of nasal endoscopic radiofrequency ablation on the stress response and ventilation function in children with obstructive sleep apnea-hypopnea syndrome （OSAHS）. Methods .Seventy-eight children with OSAHS were selected and randomly divided into observation group （39 cases） and control group （39 cases）. The control group was treated by adenoid curettage and tonsillectomy by dissection, the observation group was treated by nasal endoscopic low temperature plasma radiofrequency ablation. The total efficiency, intraoperative the blood loss, visual analogue scale （VAS） score postoperative 1 d and 3 d, serum stress index [ glutathione （GSH） malondialdehyde （MDA）, superoxide dismutase （SOD） and nitrotyrosine （3-NT）] level were compared between the two groups. The ventilation function [ time length of nocturnal oxygen saturation 〈 90% （ SLT90% ）, respiratory disturbance index （AHI）, the longest apnea time （LAT） and oxygen desaturation index （ODI） ] were detected before operation and after 6 months of operation in the two groups by polysomnography sleep time. Results The total efficiency in the observation group （94. 87% ）was higher than that in the control group （76. 92% ）, the difference was significant （P 〈0. 05 ）. Compared with the control group, the operation time, intraoperative blood loss, postoperative 1 d and 3 d score of VAS in the observation group were lower, the differences were statistically significant （ P 〈 0. 05 ）. GSH and SOD in the observation group were higher than those in the control group, MDA and 3-NT were lower than those in the control group, the differences were significant （ P 〈 0.05 ）. SLT90% , AHI, LAT and ODI had no statistically significant differences before operation between the two groups （ P 〉 0. 05 ） ; compared with the control group, LAT, AHI, ODI and SLT 90% after 6 months of operation in the observation group were significantly lower, the differences were significant （P 〈 0. 05 ）. Conclusions Nasal endoscopic low temperature plasma radiofrequency ablation in the treatment of children with OSAHS can reduce intraoperative blood loss, alleviate pain and stress reaction of children after operation, and improve ventilation function.