不同治疗手段对阻塞性睡眠呼吸暂停综合征患儿睡眠呼吸及生活质量的影响

Effects of Different Treatments on Sleep Breathing and Quality of Life in Children with Obstructive Sleep Apnea Syndrome

目的 探讨不同治疗手段对阻塞性睡眠呼吸暂停综合征患儿睡眠呼吸及生活质量的影响。方法 方便选取2018年1月—2021年8月中山市小榄人民医院收治的110例阻塞性睡眠呼吸暂停综合征患儿为研究对象,采用随机数表法将其分为保守治疗组(55例)和手术治疗组(55例)。保守治疗组患儿给予持续气道正压通气进行治疗,治疗3个月;手术治疗组患儿行内镜下腺样体扁桃体切除术治疗,术后随访3个月。比较两组治疗3个月后的临床疗效,治疗前、治疗3个月后多导睡眠图(PSG)检测指标,阻塞性睡眠呼吸暂停综合征患儿生活质量量表(OSA-18)评分及治疗期间并发症发生情况。结果 手术治疗组治疗3个月后总有效率为94.55%,高于保守治疗组的74.55%,差异有统计学意义(P<0.05)。两组治疗3个月后呼吸暂停低通气指数(AHI)、睡眠呼吸紊乱指数(RDI)、阻塞性呼吸暂停指数(OAI)、微觉醒指数(MAI)较治疗前均降低,且手术治疗组[(6.13±1.03)次/h、(4.10±1.11)次/h、(7.00±0.93)次/h、(9.17±1.93)次/h]低于保守治疗组[(14.00±1.45)次/h、(5.12±2.10)次/h、(8.10±1.12)次/h、(11.01±2.10)次/h],差异有统计学意义(t=32.815、3.185、5.604、4.784,P<0.05)。两组治疗3个月后身体症状、睡眠障碍、对患儿监护人的影响、情绪不佳、白天功能评分较治疗前均降低,且手术治疗组身体症状、睡眠障碍、白天功能评分[(13.10±1.98)分、(13.08±2.01)分、(7.13±2.60)分]均低于保守治疗组[(15.30±2.10)分、(15.40±2.00)分、(10.30±3.10)分],差异有统计学意义(t=5.653、6.068、5.811,P<0.05)。两组治疗期间并发症发生率(1.82%vs 3.64%)对比,差异无统计学意义(P>0.05)。结论 内镜下腺样体扁桃体切除术可改善阻塞性睡眠呼吸暂停综合征患儿呼吸睡眠及生活质量,提高临床疗效,且安全性良好。

Objective To explore the effects of different treatment methods on sleep breathing and quality of life in children with obstructive sleep apnea syndrome.Methods A total of 110 children with obstructive sleep apnea syndrome admitted to Zhongshan Xiaolan People's Hospital from January 2018 to August 2021 were conveniently selected as the study subjects.They were divided into a conservative treatment group(55 cases)and a surgical treatment group(55 cases)using a random number table method.The children in the conservative treatment group were treated with continuous positive airway pressure ventilation for 3 months;children in the surgical treatment group received endoscopic adenoidectomy and tonsillectomy,and were followed up for 3 months.The clinical efficacy after 3 months of treatment,polysomnography(PSG)before treatment and after 3 months of treatmen,Obstructive Sleep Apnea 18(OSA-18)score of children with obstructive sleep apnea syndrome,and complications during treatment were compared between the two groups.Results After 3 months of treatment,the total effective rate in the surgical treatment group was 94.55%,higher than 74.55%in the conservative treatment group,and the difference was statistically significant(P<0.05).After 3 months of treatment,the apnea hypopnea index(AHI),sleep apnea index(RDI),obstructive apnea index(OAI),and micro arousal index(MAI)in both groups decreased compared to those before treatment,and the surgical treatment group[(6.13±1.03)times/h,(4.10±1.11)times/h,(7.00±0.93)times/h,and(9.17±1.93)times/h]was lower than the conservative treatment group[(14.00±1.45)times/h,(5.12±2.10)times/h,(8.10±1.12)times/h,and(11.01±2.10)times/h,and the difference was statistically significant(t=32.815,3.185,5.604,4.784,P<0.05).After 3 months of treatment,physical symptoms,sleep disorders,impact on child guardians,emotional distress,and daytime function scores in both groups decreased compared to those before treatment,and physical symptoms,sleep disorders daytime functional scores[(13.10±1.98)points,(13.08±2.01)points,and(7.13±2.60)points]were lower in the surgical treatment group than in the conservative treatment group(15.30±2.10)points,(15.40±2.00)points,and(10.30±3.10)points,and the difference was statistically significant(t=5.653,6.068,5.811,P<0.05).There was no statistically significant difference in the incidence of complications during treatment between the two groups(1.82%vs 3.64%)(P>0.05).Conclusion Endoscopic adenotonsillectomy can improve respiratory sleep and quality of life in children with obstructive sleep apnea syndrome,improve clinical efficacy,with good safety.