多学科联合诊治重度儿童阻塞性睡眠呼吸暂停综合征并发肺动脉高压1例

Multidisciplinary diagnosis and treatment of a child with severe obstructive sleep apnea syndrome complicated by pulmonary hypertension

目的 探讨重度儿童阻塞性睡眠呼吸暂停综合征(OSA)并发肺动脉高压患儿的发病机制、诊疗方法及围手术期管理。方法 回顾性分析1例重度OSA并发肺动脉高压患儿的临床资料。结果 重度儿童OSA可导致肺动脉高压,对于重度OSA并发肺动脉高压的患儿,需多学科联合诊疗排除可导致肺动脉高压的其他因素,扁桃体、腺样体轻度肥大的重度OSA患儿在排除其他梗阻因素后可选择手术治疗,围手术期进行持续正压通气(CPAP)治疗可快速纠正肺动脉高压,降低围手术期风险。结论 手术联合围手术期CPAP治疗是治疗重度OSA并发肺动脉高压的有效治疗方案,多导睡眠监测是判断患儿病情严重程度及评估手术疗效的重要手段。

Objective To investigate the pathogenesis, diagnosis, treatment and perioperative management of children with severe obstructive sleep apnea(OSA) complicated by pulmonary hypertension. Methods A retrospective review of one child with OSA complicated by pulmonary hypertension is analyzed. Results Pulmonary hypertension can cause by severe OSA in children. Multidisciplinary diagnosis and treatment should be conducted for children with severe OSA complicated by pulmonary hypertension to exclude other factors that may lead to pulmonary hypertension. Surgical treatment could be chosen for children with severe OSA with mild hypertrophy of tonsil and adenoid after other obstruction factors were excluded. Perioperative CPAP therapy can rapidly correct pulmonary hypertension and reduce perioperative risk. Conclusion Operation combined with perioperative CPAP therapy is an effective treatment for severe OSA complicated by pulmonary hypertension. Polysomnography monitoring is an important means to judge the severity of children’s disease and evaluate the efficacy of surgery.