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目的:探讨儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)的临床治疗手段及疗效。方法:50例患儿通过常规临床表现、鼻咽侧位X线摄片、纤维鼻咽镜检查及部分患儿多导睡眠监测(polysomnography,PSG)确诊为OSAHS,其中45例腺样体、扁桃体肥大的患儿行扁桃体和(或)鼻内镜下腺样体切除手术,3例鼻息肉鼻窦炎患儿行鼻窦内窥镜手术,2例使用持续正压通气(continuous positive airway pressure,CPAP)治疗,评价其疗效。结果:儿童OSAHS的主要表现为入睡打鼾、张口呼吸、呼吸暂停、听力下降。50例患儿中行手术治疗48例,其中同时行扁桃体切除术加鼻内镜下腺样体切除术14例,行单纯鼻内镜下腺样体切除术18例,行单纯扁桃体切除术13例,行功能性鼻窦内窥镜手术3例,采用手术的患儿术后临床症状明显缓解,治愈36例,好转12例,手术总有效率100%。随机抽取20例患儿于术后6个月复查PSG,呼吸暂停低通气指数(apnea hypopnea index,AHI)、最低血氧饱和度LSa O2(lowest oxygen saturation)、最长的呼吸暂停时间(longest apnea,LA),与术前比较差异均有统计学意义(P<0.05)。2例肥胖低通气症患儿经CPAP治疗,效果良好。结论:儿童OSAHS的诊断区别于成人,需结合运用PSG,鼻咽侧位X线摄片、纤维鼻咽镜检查,全麻下扁桃体和(或)鼻内镜下腺样体切除术是目前治疗儿童OSAHS安全、有效的治疗手段。
Objective: To investigate the clinical treatment and efficacy of obstructive sleep apnea-hypopnea syndrome (OSAHS) in children. Methods: Fifty children were diagnosed as OSAHS by routine clinical manifestations, lateral nasopharyngeal radiography, fiber nasopharyngoscopy and polysomnography (PSG). Forty-five adenoids and tonsils Hyperthyroid children underwent tonsillectomy and / or endoscopic adenoidectomy. Three patients with nasal polyps had sinusoscopic endoscopic sinus surgery, and two patients underwent continuous positive airway pressure (CPAP) Treatment, evaluation of its efficacy. Results: The main manifestations of OSAHS in children were snoring sleep, mouth breathing, apnea, hearing loss. 50 cases of children underwent surgical treatment of 48 cases, including simultaneous tonsillectomy and endoscopic adenoidectomy in 14 cases underwent simple endoscopic adenoidectomy in 18 cases, simple tonsillectomy in 13 cases , 3 cases of functional endoscopic sinus surgery, surgery in children with clinical symptoms were significantly relieved, 36 cases were cured, improved in 12 cases, the total effective rate of 100%. Twenty patients were randomly selected to review the changes of PSG, apnea hypopnea index (AHI), LSA O2 (lowest oxygen saturation), longest apnea , LA), compared with the preoperative difference was statistically significant (P <0.05). 2 cases of obese children with hypoglycemia by CPAP treatment, the effect is good. Conclusions: The diagnosis of OSAHS in children is different from that of adults. Combined with PSG, lateral nasopharyngeal X-ray and fiber nasopharyngectomy, tonsillectomy and / or endoscopic adenoidectomy under general anesthesia is the current treatment Children OSAHS safe and effective treatment.