药物干预和手术切除治疗儿童阻塞性睡眠呼吸暂停低通气综合征的疗效评估

Efficacy of Drug Intervention and Surgical Resection in the Treatment of Obstructive Sleep Apnea Hypopnea Syndrome in Children

目的:对比分析药物干预和手术切除治疗儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的临床疗效。方法:应用随机数字表法将2015年2月至2017年11月经本院确诊的100例OSAHS患儿分为药物组、手术组,每组50例。药物组采用孟鲁司特钠治疗6个月,手术组行腺样体和扁桃体切除术。6个月后比较两组患儿多导睡眠图监(PSG)的监测结果和生活质量情况,比较两组疗效评定情况,记录手术组无效及并发症的原因。结果:6个月后,药物组、手术组患儿呼吸暂停低通气指数(AHI)、阻塞性呼吸暂停指数(OAI)、微觉醒指数(MAI)和睡眠呼吸紊乱指数(RDI)较治疗前降低,且手术组患儿AHI低于药物(P<0.05)。手术组患儿6个月后睡眠障碍、对监护人的影响、身体症状评分较治疗前降低,且低于药物组(P<0.05),而药物组治疗前后OSA-18评分各指标比较差异无统计学意义(P>0.05)。手术组患儿总有效率为90.00%(45/50),高于药物组的50.00%(25/50),差异有统计学意义(P<0.05)。手术组患儿有出血现象的4例、伴舌后坠2例、上呼吸反复道感染6例和鼻炎5例,无效的5例患儿为伴有肥胖的重度OSAHS。结论:对于OSAHS患儿,药物干预和手术切除均可改善患儿PSG指标水平,但手术切除治疗可提高患儿生活质量和治疗有效率。

Objective: To comparative analysis the clinical efficacy of drug intervention and surgical resection in the treatment of obstructive sleep apnea hypopnea syndrome(OSAHS) in children. Methods: 100 children with OSAHS diagnosed in our hospital from February 2015 to November 2017 were divided into drug group and operation group by random number table method, 50 cases in each group. The drug group was treated with montelukast for 6 months, while the operation group underwent adenoadenectomy and tonsillectomy. After 6 months, the polysomnography(PSG) monitoring results and quality of life between the two groups were compared. The efficacy of each group was compared, and the reasons for invalid operation and complications were recorded. Results: After 6 months,the apnea hypopnea index(AHI), obstructive apnea index(OAI), micro awakening index(MAI) and respiratory disturbance index(RDI)in the drug group and the operation group were lower than before treatment, and the AHI in the operation group was lower than that in the drug group(P<0.05). After 6 months, the sleep disorder, influence on the guardian, scores of the body symptoms in the operation group were lower than before treatment, and lower than in the drug group(P<0.05), but there was no significant difference between the OSA-18 scores of the drug group before and after the treatment(P>0.05). The total effective rate in the operation group were 90.00%(45/50),which were higher than 50.00%(25/50) in the drug group, the difference was statistically significant(P<0.05). There were 4 cases of bleeding in the operation group, 2 cases with lingual fall, 6 cases of recurrent upper respiratory tract infection and 5 cases of rhinitis, and5 cases of ineffective children with severe OSAHS with obesity. Conclusion: For children with OSAHS, drug intervention and surgical resection can improve the level of PSG in children, but surgical resection can improve the quality of life and treatment efficiency in children.