低温等离子刀扁桃体腺样体切除治疗儿童阻塞性睡眠呼吸暂停综合征临床分析

Clinical Analysis of Tonsill Adenoidectomy with Hypothermia Plasma Knife in Children with Obstructive Sleep Apnea Syndrome

目的探讨低温等离子刀扁桃体腺样体切除在儿童阻塞性睡眠呼吸暂停综合征(OSAHS)治疗中的应用及临床效果。方法选择平邑县人民医院2017年6月-2019年3月144例OSAHS儿童,随机分为对照组(n=72)及研究组(n=72),对照组采用传统扁桃体腺样体切除术,研究组采用低温等离子刀行扁桃体腺样体切除术,比较两术中情况、术后恢复情况及术后通气改善情况。结果手术时间、术中出血量、术后疼痛时间对照组为(37.6±5.7)min、(32.4±5.6)mL及(3.6±0.9)d,研究组为(13.2±4.6)min、(7.6±2.9)mL及(2.1±0.7)d,研究组手术时间、术中出血量、术后疼痛时间少于对照组(t=8.926,P=0.000;t=11.504,P=0.000;t=3.497,P=0.008)。术前呼吸暂停低通气指数(AHI)、氧减指数(ODI),最低血氧饱和度(LoSPO2)对照组分别为(16.2±2.4)次/min,(9.4±1.4)次/h,(84.6±5.2)%,研究组分别为(16.7±2.8)次/min,(9.6±1.9)次/h,(84.9±5.7)%,术后对照组分别为(2.9±0.09)次/min,(2.3±0.6)次/h,(89.7±3.9)%,研究组分别为(2.8±0.7)次/min,(2.4±0.8)次/h,(90.2±4.1)%,两组间治疗前各指标差异无统计学意义(P>0.05),两组术后AHI、ODI均较治疗前降低(P<0.05),LoSPO2增高(P<0.05),两组间术后各指标差异无统计学意义(P>0.05)。研究组并发症发生率为1.3%,对照组并发症发生率为6.9%,研究组并发症发生率低于对照组(χ^2=3.976,P=0.012)。结论低温等离子刀扁桃体腺样体切除治疗儿童OSAHS能够减少手术创伤,减少并发症的发生,促进患者术后康复,改善睡眠及通气质量,具有较好的临床效果。

Objective To investigate the application and clinical effect of low temperature plasma knife tonsil adenoidectomy in the treatment of childhood obstructive sleep apnea syndrome(OSAHS).Methods 144 children with OSAHS from Pingyi County People's Hospital from June 2017 to March 2019 were randomly divided into a control group(n=72)and a study group(n=72).The control group was treated with traditional tonsil adenoidectomy.The study group used a low-temperature plasma knife to perform tonsillectomy,and compared the intraoperative situation,postoperative recovery,and postoperative ventilation improvement.Results The operation time,intraoperative blood loss,and postoperative pain time in the control group were(37.6±5.7)min,(32.4±5.6)mL,and(3.6±0.9)d,and the study group was(13.2±4.6)min,(7.6±2.9)mL,and(2.1±0.7)d in the control group.The operation time,intraoperative blood loss,and postoperative pain time in the study group were less than those in the control group(t=8.926,P=0.000;t=11.504,P=0.000;t=3.497,P=0.008).The preoperative apnea hypopnea index(AHI),oxygen reduction index(ODI),and minimum blood oxygen saturation(LoSPO2)in the control group were(16.2±2.4)times/min,(9.4±1.4)times/h,and(84.6±5.2)%;the study group was(16.7±2.8)times/min,(9.6±1.9)times/h,(84.9±5.7)%,and the postoperative control group were(2.9±0.09)times/min,(2.3±0.6)times/h,and(89.7±3.9)%,the study group was(2.8±0.7)times/min,(2.4±0.8)times/h,(90.2±4.1)%.There were no statistically significant differences in the indexes before treatment between the two groups(P<0.05).ODI and ODI were lower than before treatment(P<0.0),and LoSPO2 increased(P<0.05).There was no statistically significant difference in postoperative indicators between the two groups(P>0.05).The incidence of complications in the study group was 1.3%,and the incidence of complications in the control group was 6.9%.The incidence of complications in the study group was lower than that in the control group(χ^2=3.976,P=0.012).Conclusion Low-temperature plasma knife tonsil adenoidectomy in children with OSAHS can reduce surgical trauma,reduce the incidence of complications,promote postoperative rehabilitation,improve sleep and ventilation quality,and has good clinical effects.