升麻解毒汤联合鼻内镜下低温等离子消融术对腺样体扁桃体肥大所致阻塞性睡眠呼吸暂停患儿最低动脉血氧饱和度血清瘦素水平多导睡眠监测指标及免疫功能的影响

Effects of low-temperature plasma ablation combined with Shengma Detoxification Decoction under nasal endoscopy on LSaO_(2),serum leptin levels,PSG monitoring indicators,and immune function in children with obstructive sleep apnea caused by adenoid tonsil hypertrophy

目的探究鼻内镜下升麻解毒汤联合低温等离子消融术对腺样体及扁桃体肥大所致阻塞性睡眠呼吸暂停患儿最低动脉血氧饱和度(LSaO_(2))、血清瘦素、多导睡眠监测(PSG)指标及免疫功能的影响。方法回顾性选取2021年9月至2022年9月浙江省宁海县第一医院收治的98例阻塞性睡眠呼吸暂停低道气综合征患儿,按治疗方式分为观察组(鼻内镜下低温等离子消融术加升麻解毒汤)和对照组(鼻内镜下低温等离子消融术)各49例。比较2组患儿的手术情况、治疗有效率、并发症发生情况、术前术后免疫功能指标、呼吸暂停低通气指数(AHI)、LSaO_(2)、血清瘦素水平、PSG监测指标等。结果观察组治疗总有效率为96%,高于对照组的85%(P<0.05)。观察组患儿在术中出血量(11.4±2.6)ml、术后通气恢复时间(5.9±1.0)d和术后疼痛持续时间(6.2±1.2)d均低于对照组[(16.8±2.4)ml、(7.6±1.4)d、(7.2±1.2)d],差异有统计学意义(P<0.05)。治疗后,观察组的LSaO_(2)水平[(95.6±1.1)%],高于对照组[(91.3±0.9)%](P<0.05)。治疗后,观察组的AHI水平[(3.0±0.9)次/h]较对照组更低[(8.2±1.8)次/h](P<0.05),治疗后,观察组患者的免疫指标水平与对照组相比差异无统计学意义(P>0.05)。观察组患儿的并发症发生率(1%)低于对照组(6%,P<0.05)。治疗后,观察组患者血清瘦素水平[(5.1±1.2)μg/L],明显低于对照组[(10.6±2.0)μg/L](P<0.05)。治疗后,观察组平均呼吸暂停时间[(16.1±1.5)s]、低通气指数[(28.1±2.1)%]、呼吸紊乱指数[(22.2±2.2)次/h],明显低于对照组[(21.2±1.4)s、(34.3±2.1)%、(29.1±2.0)次/h],差异有统计学意义(P<0.05)。结论鼻内镜下低温等离子消融术联合升麻解毒汤对腺样体及扁桃体肥大引起的阻塞性睡眠呼吸暂停患儿具有显著的临床疗效。该治疗方案在提高患儿术后氧饱和度水平、降低呼吸暂停低通气指数方面表现出色,同时对患儿的免疫功能和术后并发症影响较小,调节机体血清瘦素水平与PSG监测指标,具有临床推广价值。

Objective To explore the effects of low-temperature plasma ablation combined with Shengma Detoxification Decoction under nasal endoscopy on LSaO_(2),serum leptin levels,PSG monitoring indicators,and immune function in children with obstructive sleep apnea caused by adenoid tonsil hypertrophy.Methods Retrospective selection of 98 pediatric snoring patients admitted to First Hospital of Ninghai County from September 2021 to September 2022 were divided into an observation group(treated with low-temperature plasma ablation under nasal endoscopy and oral administration of Shengma Detoxification Decoction)and a control group(treated with low-temperature plasma ablation under nasal endoscopy),with 49 cases in each group.The surgical conditions,treatment effectiveness,incidence of complications,preoperative and postoperative immune function indicators,sleep breathing temporary LSaO_(2) indicators,serum leptin levels,PSG monitoring indicators,etc.between two groups of children were compared.Results The total effective rate of observation group was 96%,which was significantly higher than that of control group 85%(P<0.05).The intraoperative blood loss(11.4±2.6)ml,postoperative ventilation recovery time(5.9±1.0)d and postoperative pain duration(6.2±1.2)d in the observation group were significantly shorter than those in the control group[(16.8±2.4)ml,(7.6±1.4)d,(7.2±1.2)d],the difference was statistically significant(P<0.05).After treatment,the LSaO_(2) level in the observation group was(95.6±1.1)%,which was higher than that in the control group(91.3±0.9)%(P<0.05).After treatment,AHI level of the observation group(3.0±0.9)times/h was lower than that of the control group(8.2±1.8)times/h(P<0.05).The immune index levels of the observation group were compared with those of the control group,but there were no significant differences(P>0.05).The incidence of complications in the observation group was 1%,which was significantly lower than 6%in the control group(P<0.05).After treatment,the serum leptin level of the observation group(5.1±1.2)μg/L was significantly lower than that of control group(10.6±2.0)μg/L(P<0.05).After treatment,the average apnea time of the observation group was(16.1±1.5)s,the hypopnea index was(28.1±2.1)%,and the respiratory disturbance index was(22.2±2.2)events/h.It was significantly lower than the control group[(21.2±1.4)s,(34.3±2.1)%,(29.1±2.0)events/h],and the difference was statistically significant(P<0.05).Conclusion The combination of low-temperature plasma ablation under nasal endoscopy and Shengma Detoxification Decoction has significant clinical efficacy in treating children with obstructive sleep apnea caused by adenoid tonsil hypertrophy.This treatment plan shows excellent performance in improving postoperative oxygen saturation levels and reducing the apnea hypopnea index of children.At the same time,it has little impact on the immune function and postoperative complications of children.It regulates serum leptin levels and PSG monitoring indicators,and has clinical value for in-depth promotion and research.