小儿鼾症手术联合下鼻甲后端消融术对鼻腔通气功能的影响

宫玲玲; 王伟; 蒋成义; 詹晓东

doi:10.16766/j.cnki.issn.1674-4152.002810

小儿鼾症手术联合下鼻甲后端消融术对鼻腔通气功能的影响

doi: 10.16766/j.cnki.issn.1674-4152.002810

蚌埠医学院第一附属医院耳鼻咽喉头颈外科, 安徽蚌埠 233004

基金项目:

安徽省重点研究与开发计划基金项目 202104j07020015

详细信息

通讯作者:
詹晓东，E-mail: zxdent2007@aliyun.com

中图分类号: R765.9 R766
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出版历程
- 收稿日期: 2022-04-18

Influence of paediatric snoring combined with posterior inferior distribution of the ventilation function on nasal ventilation

Department of Otolaryngology and Head and Neck Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的鼾症患儿病因多且复杂，部分患儿常规扁桃体及腺样体切除术后效果不佳，本研究将小儿鼾症手术与下鼻甲后端消融术联合应用，探讨其在改善鼻腔通气功能的应用价值。方法纳入蚌埠医学院第一附属医院耳鼻咽喉头颈外科于2021年6—12月期间收治的60例经过多导睡眠监测(PSG)确诊的小儿鼾症患儿，采用随机数字表法将患儿分为对照组(30例，行鼻内镜下低温等离子扁桃体切除及腺样体消融术)和实验组(30例，行鼻内镜下低温等离子扁桃体及腺样体切除联合下鼻甲后端消融术)。治疗前后均行PSG、鼻阻力测定及儿童阻塞性睡眠呼吸暂停低通气综合征特异性生活质量调查(OSA-18)量表填写。比较2组术前、术后6个月的睡眠呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO₂)相关水平及OSA-18量表总评分，2组中鼻阻力值异常患儿术后第1、2、3周的鼻阻力值。结果实验组患儿术后的AHI[(3.60±1.63)次/min]、LSaO₂[(96.07±2.29)%]指标及OSA-18总评分[(22.57±2.79)分]优于对照组[(8.63±1.30)次/min、(91.23±1.22)%、(25.57±4.71)分]，差异均有统计学意义(均P＜0.05)；术后第1周2组鼻阻力与术前相比均无明显改善(均P>0.05)，术后第2、3周2组鼻阻力均显著改善(均P＜0.05)，且实验组鼻阻力改善明显优于对照组(均P＜0.05)。结论鼻阻力异常患儿行鼻内镜下低温等离子扁桃体切除及腺样体消融联合下鼻甲后端消融术更有利于改善患儿术后鼻腔通气功能, 提高患儿生活质量。
- 小儿鼾症 /
- 扁桃体切除及腺样体消融术 /
- 下鼻甲后端消融术 /
- 鼻腔通气
Abstract: Objective The causes of snoring in children are multiple and complex, and the effect of routine flat gland resection in some children is poor. This study will combine snoring surgery with posterior end ablation of inferior turbinate in children to explore its application value in improving nasal ventilation function. Methods A total of 60 children with severe snoring [obstructive sleep apnea (OSA)] diagnosed by polysomnography (PSG) in the Department of Otolaryngology and Head and Neck Surgery of the First Affiliated Hospital of Bengbu Medical College from June 2021 to December 2021 were selected and randomly divided into control group (30 cases, thermic tonsils under a nasal endoscopy and adenoid ablation) and experimental group (30 cases, underwent endoscopic low oil into nasal and adenoidectomy combined with ablation of the posterior end of the inferior tribute). Before and after treatment, PSG and nasal resistance were measured, and disease specific quality of life survey (OSA-18) for children with obstructive sleep apnea hypopnea syndrome (OSAHS) were completed. The AHI, LSaO₂ levels, OSA-18 scale scores, and nasal resistance values at 1, 2 and 3 weeks after surgery of children with abnormal nasal resistance value were compared between the two groups before surgery and 6 months after surgery. Results The AHI [(3.60±1.63) times/min], LSaO₂ indexes (96.07%±2.29%) and OSA-18 total score [(22.57±2.79) points] of the experimental group were better than those of the control group [(8.63±1.30) times/min, 91.23%±1.22% and (25.57±4.71) points], and the differences were statistically significant (all P < 0.05). No significant improvement in nasal resistance was observed in the first week after surgery (P>0.05), and the nasal resistance in the second and third weeks after surgery was significantly improved (all P < 0.05) compared with before surgery. In addition, the nasal resistance in the experimental group was significantly better than that in the control group (all P < 0.05). Conclusion Endoscopic low-temperature plasma tonsillectomy and adenoid ablation combined with posterior and inferior distribution of ablation in children with abnormal resistance are more conducive to improving post-operative function and quality of life.
- Paediatric snoring /
- Tonsillectomy and adenoid ablation /
- Posterior inferior turbinate ablation /
- Nasal ventilation
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表 1 2组OSAHS患儿治疗前后AHI、LSaO₂比较(x ±s)

Table 1. AHI and LSaO₂ of children with severe OSA before and after treatment (x ±s)

组别	例数	AHI(次/min)		LSaO₂(%)
组别	例数	术前	术后6个月	术前	术后6个月
实验组	30	16.43±1.52	3.60±1.63^a	75.00±2.32	96.07±2.29^a
对照组	30	17.27±1.17	8.63±1.30^a	74.03±3.03	91.23±1.22^a
t值		2.374	13.217	1.386	10.203
P值		0.115	＜0.001	0.171	＜0.001
注：与术前比较，^aP＜0.05。

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表 2 2组OSAHS鼻阻力异常患儿鼻阻力值比较(x ±s)

Table 2. Nasal resistance values between two groups of children with abnormal nasal resistance in OSAHS(x ±s)

组别	例数	术前	术后1周	术后2周	术后3周
实验组	20	1.006±0.155	0.898±0.141	0.618±0.071^a	0.247±0.034^a
对照组	17	0.950±0.121	0.899±0.114	0.829±0.066^a	0.388±0.144^a
t值		1.215	0.017	9.289	3.981
P值		0.233	0.987	＜0.001	0.001
注：与术前比较, ^aP＜0.05。

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表 3 2组OSAHS患儿治疗前后OSA-18总评分比较(x ±s，分)

Table 3. Total score of OSA-18 status before and after treatment in the two groups(x ±s, points)

组别	例数	术前	术后6个月	t值	P值
实验组	30	67.07±5.53	22.57±2.79	37.103	＜0.001
对照组	30	68.45±6.59	25.57±4.71	30.956	＜0.001
t值		0.891	3.002
P值		0.377	0.004

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参考文献(16)

[1]	张洋, 付勇. 儿童阻塞性睡眠呼吸暂停治疗进展[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(8): 756-760. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH202108019.htm ZHAG Y, FU Y. Progress in the treatment of obstructive sleep apnea in children[J]. Clin J Otorhinolaryngology Head and Neck Surgery, 2021, 35(8): 756-760. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH202108019.htm
[2]	GARG R K, AFIFI A M, GARLAND C B, et al. Pediatric obstructive sleep apnea: consensus, controversy, and craniofacial considerations[J]. Plast Reconstr Surg, 2017, 140(5): 987-997. doi: 10.1097/PRS.0000000000003752
[3]	郭靖晗, 李远远, 刘月华. 儿童阻塞性睡眠呼吸暂停低通气综合征治疗的研究进展[J]. 复旦学报(医学版), 2020, 47(5): 783-788. doi: 10.3969/j.issn.1672-8467.2020.05.022 GUO J H (review), LI Y Y, LIU Y H (review). Research progress in the treatment of obstructive sleep apnea hypopnea syndrome in children[J]. Journal of Fudan University: Medical Science, 2020, 47(5): 783-788. doi: 10.3969/j.issn.1672-8467.2020.05.022
[4]	刘云亮, 李丽娟, 李涛, 等. 扁桃体部分切除联合腺样体切除术治疗儿童阻塞性睡眠呼吸暂停低通气综合征的中期疗效[J]. 中国微创外科杂志, 2019, 19(12): 1100-1102. doi: 10.3969/j.issn.1009-6604.2019.12.011 LIU Y L, LI L J, LI T, et al. Effect of partial tonsillectomy combined with adenoidectomy on obstructive sleep apnea hypopnea syndrome in children[J]. Chin J Minimally Invasive Surgery, 2019, 19(12): 1100-1102. doi: 10.3969/j.issn.1009-6604.2019.12.011
[5]	倪鑫. 中国儿童阻塞性睡眠呼吸暂停诊断与治疗指南(2020)[J]. 中国循证医学杂志, 2020, 20(8): 883-900. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZXZ202008005.htm N X,Chinese Guidelines for diagnosis and treatment of obstructive sleep apnea in children (2020)[J]. Chin J Otorhinolaryngology Head and Neck Surgery, 2020, 20(8): 883-900. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZXZ202008005.htm
[6]	严降雨, 殷敏, 李静, 等. 临床评估鼻阻力的方法学研究[J]. 中国中西医结合耳鼻咽喉科杂志, 2016, 24(3): 184-189, 183. https://www.cnki.com.cn/Article/CJFDTOTAL-XYJH201603008.htm YAN J Y, YIN M, LI J, et al. Clinical evaluation of nasal resistance: a methodological study[J]. Chinese Journal of Integrated Traditional and Western Medicine Otolaryngology, 016, 24(3): 184-189, 183. https://www.cnki.com.cn/Article/CJFDTOTAL-XYJH201603008.htm
[7]	ZHANG Q B, LI Y F, LI M X, et al. Adenotonsillectomy outcomes regarding bone age and osteocalcin in treatment of obstructive sleep apnea syndrome in children[J]. World J Pediatr, 2017, 13(2): 158-164. doi: 10.1007/s12519-016-0073-3
[8]	何梦藻, 赵烨钧, 金剑, 等. 儿童阻塞性睡眠呼吸暂停低通气综合征的糖脂代谢变化分析[J]. 中华全科医学, 2017, 15(2): 264-266, 281. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.025 HE M Z, ZHAO Y J, JIN J, et al. Analysis of changes in glucose and lipid metabolism in children with obstructive sleep apnea hypopnea syndrome[J]. The Chinese General Medicine, 2017, 15(2): 264-266, 281. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.025
[9]	应旭阳, 严嘉宁, 吴军华. 儿童阻塞性睡眠呼吸暂停低通气综合征致相关系统损伤研究进展[J]. 现代实用医学, 2022, 34(1): 134-138. https://www.cnki.com.cn/Article/CJFDTOTAL-NBYX202201062.htm YING X Y, YAN J N, WU J H. Research progress of obstructive sleep apnea hypopnea syndrome in children[J]. Modern Practical Medicine, 2022, 34(1): 134-138. https://www.cnki.com.cn/Article/CJFDTOTAL-NBYX202201062.htm
[10]	张洋, 付勇. 儿童阻塞性睡眠呼吸暂停治疗进展[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(8): 756-760. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH202108019.htm ZHANG Y, FU Y. Progress in the treatment of obstructive sleep apnea in children[J]. Clin J Otorhinolaryngology Head and Neck Surgery, 2021, 35(8): 756-760. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH202108019.htm
[11]	娄凡, 马静, 江茹, 等. 阻塞性睡眠呼吸暂停低通气综合征儿童的鼻气流变化及影响因素分析[J]. 中国耳鼻咽喉头颈外科, 2019, 26(1): 51-53. https://www.cnki.com.cn/Article/CJFDTOTAL-EBYT201901016.htm LOU F, MA J, JIANG R, et al. Analysis of nasal airflow and its influencing factors in children with obstructive sleep apnea hypopnea syndrome[J]. Chinese Journal of Otolaryngology Head and Neck Surgery, 2019, 26(1): 51-53. https://www.cnki.com.cn/Article/CJFDTOTAL-EBYT201901016.htm
[12]	祖金艳, 娄凡, 明澄, 等. 鼻阻力测定在儿童OSA诊疗中的临床作用[J]. 昆明医科大学学报, 2021, 42(12): 101-105. https://www.cnki.com.cn/Article/CJFDTOTAL-KMYX202112018.htm ZU J Y, LOU F, MING C, et al. Clinical role of nasal resistance measurement in the diagnosis and treatment of OSA in children[J]. Journal of Kunming Medical University, 2021, 42(12): 101-105. https://www.cnki.com.cn/Article/CJFDTOTAL-KMYX202112018.htm
[13]	LEI R, LUO Z, SU D, et al. Nasal airflow resistance measured by rhinomanometry in a healthy population of China[J]. Int Forum Allergy Rhinol, 2018, 8(11): 1308-1314.
[14]	祖金艳, 马静, 娄凡, 等. 鼻阻力测定在腺样体肥大患儿中的诊疗意义[J]. 中国医学文摘(耳鼻咽喉科学), 2021, 36(1): 4-6, 249. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYEB202101002.htm ZU J Y, MA J, LOU F, et al. Clinical significance of nasal resistance measurement in children with adenoid hypertrophy[J]. Chin Medical Abstract: Otorhinolaryngology, 2021, 36(1): 4-6, 249. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYEB202101002.htm
[15]	康尧杰, 于凌昱, 张虹婷, 等. 鼻声反射与鼻阻力测量的临床应用及进展[J]. 中国耳鼻咽喉颅底外科杂志, 2016, 22(2): 165-168. https://www.cnki.com.cn/Article/CJFDTOTAL-ZEBY201602029.htm KANG Y J, YU L L, ZHANG H T, et al. Clinical application and progress of nasal acoustic reflex and nasal resistance measurement[J]. Chinese Journal of Otorhinolaryngology Skull Base Surgery, 2016, 22(2): 165-168. https://www.cnki.com.cn/Article/CJFDTOTAL-ZEBY201602029.htm
[16]	任小东, 蒋晓平, 陈天宾, 等. 鼻内窥镜下低温等离子射频消融术与扁桃体联合腺样体切除术治疗小儿鼾症伴过敏性鼻炎疗效比较[J]. 现代中西医结合杂志, 2017, 26(9): 928-931. https://www.cnki.com.cn/Article/CJFDTOTAL-XDJH201709005.htm REN X D, JIAG X P, CHEN T B, et al. Comparison of low temperature plasma radiofrequency ablation and tonsillectomy combined with adenoidectomy in the treatment of children with snoring complicated with allergic rhinitis[J]. Journal of Integrated Traditional Chinese and Western Medicine, 2017, 26(9): 928-931. https://www.cnki.com.cn/Article/CJFDTOTAL-XDJH201709005.htm