摘要
目的分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿手术前后多道睡眠监测(PSG)相关参数的特征及变化。方法选取2017年1月1日至2018年3月31日于清华大学附属北京清华长庚医院耳鼻咽喉头颈外科因腺样体和/或扁桃体肥大行腺样体和/或扁桃体切除术,且均于术前行标准PSG检查的238例患儿的病例资料,其中确诊为OSAHS的患儿被要求在术后1~3个月复查PSG。对病例资料完整的患儿手术前后的PSG结果进行对比分析,采用配对t检验对手术前后相关指标进行对比分析,独立样本t检验对不同指标及亚组之间的数据进行分析比较,如数据不符合正态分布,则以秩和检验进行相关数据的统计分析。结果 238例患儿中,62例患儿确诊为OSAHS,56例患儿完成PSG复查。62例OSAHS患儿中,有35例(56.45%)患儿以低通气事件为主,有18例(29.03%)以中枢性呼吸暂停事件为主,仅9例(14.52%)以阻塞性呼吸暂停事件为主。完成PSG复查的58例患儿中,腺样体和/或扁桃体切除术对儿童OSAHS的短期治愈率为85.71%(48/56)。术后呼吸暂停低通气指数(AHI)、混合性呼吸暂停指数(MAI)、中枢性呼吸暂停指数(CAI)、低通气指数(HI)、最低脉搏血氧饱和度(LoSpO2)、氧减指数(ODI)、Ⅰ期睡眠比例、微觉醒指数均较术前降低,差异均有统计学意义(P值均<0.05);而阻塞性呼吸暂停指数(OAI)较术前的降低差异无统计学意义(P>0.05)。Ⅱ期睡眠比例、快速眼动期睡眠比例均较术前升高,差异均有统计学意义(P值均<0.05)。Ⅲ期睡眠比例及睡眠有效率术前术后差异均无统计学意义(P值均>0.05)。以中枢性呼吸暂停事件为主的患儿,术后CAI较术前降低,差异有统计学意义(t=2.32,P=0.017)。结论腺样体/扁桃体切除可以明显地减少OSAHS患儿的呼吸事件,改善睡眠结构。但术后部分患儿病情不能得到完全缓解,需进行长期的随诊或干预。
Objective To determine the objective effects of adenotonsillectomy on pediatric obstructive sleep apnea hypopnea syndrome (OSAHS) through analyzing the polysomnography (PSG) results between pre and post-operation. Methods A total of 56 pediatric OSAHS patients were included who underwent adenoidectomy or/and tonsillectomy and completed PSG follow-up from January 1, 2017 to March 31, 2018. All the pediatric patients who underwent adenoidectomy or/and tonsillectomy during the research period were arranged to take a preoperative PSG study. Patients who were diagnosed OSAHS would be encouraged to complete a follow-up PSG study ranged from1 to 3 months after surgery. The parameters of respiration and sleep architecture of PSG were compared and analyzed. The paired student t test was used to compare preoperative and postoperative mean values. The unpaired student t test was used to compare quantitative variables among different groups. The rank sum test was used if the data were abnormal distribution. Results Totally 238 patients completed preoperative PSG study, 62 patients were diagnosed as pediatric OSAHS, 56 eligible patients finished post-operative PSG. Hypopnea was the majority in all type of respiratory events in 56.45%(35/62) subjects, while central apnea as the majority in 29.03%(18/62) subjects who can also get significant CAI decrease after surgery. However, obstructive apnea as the majority only exist in 14.52%(9/62) subjects. The short-term cure rate of pediatric OSAHS was 85.71%(48/56). The postoperative AHI, MAI, CAI, HI, ODI, LoSpO2, percentage of stage Ⅰ sleep and arousal index were significantly decreased, however, the OAI was no statistical decrease. The percentage of stage Ⅱ and rapid eye movement (REM) sleep were significantly increased, while no significant change in percentage of slow wave sleep and sleep efficiency(t=2.32, P=0.017). Conclusions Pediatric OSAHS manifest different characteristics of respiratory events from that of adults. Adenotonsillectomy can significant decrease respiratory
作者
尹国平
叶京英
顼晋昆
曹鑫
赵春梅
张玉焕
Yin Guoping;Ye Jingying;Xu Jinkun;Cao Xin;Zhao Chunmei;Zhang Yuhuan(Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China)
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2019年第5期367-372,共6页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金
扬帆计划-北京市医管局临床技术创新项目(XMLX201703).
