应用上颌快速扩弓治疗青少年阻塞性睡眠呼吸暂停综合征的效果评价——Meta分析

Rapid maxillary expansion for pediatric obstructive sleep apnea： a systematic review and metaanalysis

目的 应用Meta分析的方法评价上颌快速扩弓技术治疗青少年阻塞性睡眠呼吸暂停低通气综合征的效果.方法 检索PubMed、Cochrane数据库、Web of Science、中国知网等数据库中关于上颌快速扩弓技术治疗青少年睡眠呼吸暂停相关的实验研究,通过NICE质量评估工具对纳入文献进行质量评价并采用RevMan5.3软件进行Meta分析.结果 15篇文献报道共计346例阻塞性睡眠呼吸暂停综合征伴硬腭高拱和或过窄患者纳入此研究.根据随访时间分别进行分析：小于3 年（323例）或大于3年（52例）.对于随访小于3年的患者,随机效应模型显示呼吸暂停低通气指数（apnea-hypopnea index,AHI）变化的标准化均差为-1.52,P＜0.05,差异有统计学意义.以AHI＜1/h为标准,统计的100例患者的总体治愈率为28％;随机效应模型显示最低氧饱和度变化的标准化均差为1.60,P＜0.05,差异有统计学意义.对于随访大于3年的患者,AHI变化的均差为-7.45/h,P＜0.05,差异有统计学意义;最低氧饱和度变化的均差为2.10,P＜0.05,差异有统计学意义.增殖腺扁桃体切除术患者,随机效应模型显示AHI变化的均差为-3.49/h,P＜0.05,差异有统计学意义;无手术的小扁桃体患者,随机效应模型显示AHI变化的均差为-9.34/h,P＜0.05,差异有统计学意义;无手术的大扁桃体患者,固定效应模型显示AHI变化的均差为-4.87/h,P＜0.05,差异有统计学意义.结论 上颌快速扩弓技术可以显著改善青少年OSAHS患者的AHI及最低氧饱和度指标;对于青少年OSAS患者（包括拒绝手术的腺样体肥大患者）RME同样是一个较好的治疗方法.

Objective To perform a systematic review with meta-analysis for sleep study outcomes in children,with obstructive sleep apnea （OSAHS）,treated with rapid maxillary expansion （RME）.Methods Literatures about RME for the treatment of OSAHS were searched from the database：PubMed,Cochrane library,Web of Science,and China National Knowledge Infrastructure （CNKI）and so on.All the literatures were evaluated using National Institute for health and clinical excellence tool and analyzed using RevMan 5.3.Results Fifteen studies reported outcomes for 346 children with high-arched and/or narrow hard palates and OSAHS.Data were analyzed based on follow-up duration：〈3 years （323 patients） and 〉3 years （52 patients）.For 〈3-year follow-up,the random effects modeling demonstrated for AHI SMD was-1.52 （P〈0.05）.The cure rate（AHI〈1/ hr）for 100 patients was 28%.Random effects modeling for lowest oxygen saturation SMD was 1.60 （P〈0.05）.For 〉3-year follow-up,the AHI MD was-7.45/hr （P〈0.05）.The lowest oxygen saturation MD was 2.10 （P〈0.05）.For the previous adenotonsillectomy,the random effects modeling demonstrated for AHI MD was-3.49/hr （P〈0.05）.For the small tonsils with no prior surgery,the random effects modeling demonstrated AHI MD was-9.34/hr （P〈0.05）.For the large tonsils with no prior surgery,the fixed effects modeling demonstrated AHI MD was-4.87/hr （P〈0.05）.Conclusions Improvement in AHI and lowest oxygen saturation had consistently been seen in children treated with RME.RME was also a better treatment for adolescent with OSAHS,including those who refused the operation of adenoidal hypertrophy.