1例儿童阻塞性睡眠呼吸暂停综合征诊疗分析

Analysis on Diagnosis and Treatment of Obstructive Sleep Apnea Syndrome in One Child

儿童阻塞性睡眠呼吸暂停综合征(OSAHS)的发病率较高,但由于儿童表达能力欠缺,且该疾病短时间内通常不会引起不适症状,因此容易被家长忽视,导致很少有儿童因为该疾病的主诉而就诊,医护人员的主动问诊和早期筛查尤为重要。该文案例中,患儿因“发热、咽痛1 d”就诊,主要诊断并非OSAHS。但通过接诊医师的主动询问及进一步筛查,发现患儿可能存在OSAHS。临床上,OSAHS的早发现、早确诊、早治疗对改善患儿预后具有重要意义。如果长期不加干预,会造成神经认知、心脑血管方面的损害和代谢的变化等,严重危害患儿健康。OSAHS诊断的金标准是夜间多导睡眠监测,治疗主要是扁桃体腺样体切除术等外科手术,属于专科范畴。作为全科医生,在儿童OSAHS的诊疗过程中,如何实现对患儿的全周期、持续性、全面照顾是值得讨论的问题。该文从1例典型案例出发,对儿童OSAHS的全科诊疗原则进行阐述。

Obstructive sleep apnea hypopnea syndrome(OSAHS)has a high incidence in children,but due to the lack of expression in children and the disease usually does not cause discomfort symptoms in a short time,it is extremely easy to be ignored by parents,so few children see a doctor because of the main complaint of the disease.The active consultation and early screening of medical staff are particularly important.In this case,the child was initially treated with"fever and sore throat for 1d",and the main diagnosis was not OSAHS.However,through the active inquiry and further screening of the receiving physician,it was found that the child may have OSAHS.In clinical practice.,early detection,early diagnosis and early treatment of OSAHS are of great significance to improve the prognosis of affected children.If there is no intervention for a long time,it will cause neurocognitive,cardiovascular and cerebrovascular damage and metabolic changes,which are seriously harmful to the health of affected children.The gold standard for the diagnosis of OSAHS is nighttime polysomnographic monitoring,and the treatment is mainly surgery such as tonsillectomy,which belongs to the specialized category.As a general practitioner,how to achieve the whole-cycle,continuous and comprehensive care of affected children in the diagnosis and treatment of pediatric OSAHS is a concerned topic.Starting from a typical case,this article expounds the principles of general practice diagnosis and treatment of pediatric OSAHS.