低温等离子系统联合腺样体扁桃体切除术治疗OSAHS患儿的临床疗效及安全性分析
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摘要
目的研究低温等离子系统联合腺样体扁桃体切除术治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿的临床疗效及安全性。方法 OSAHS患儿518例,按手术方式分为传统手术组268例,等离子组250例。传统手术组采用传统腺样体扁桃体切除术,等离子组采用低温等离子系统联合腺样体扁桃体切除术,术后均随访6月。比较两组围术期相关指标,手术前及手术后6月呼吸紊乱指数、最低血氧饱和度及平均血氧饱和度及T淋巴细胞亚群,比较两组术后并发症发生率。结果等离子组住院时间、手术时间、术中出血量均低于传统手术组,差异有统计学意义(P <0. 05);与手术前相比,手术后两组患儿呼吸紊乱指数均降低,最低血氧饱和度及平均血氧饱和度水平均上升,CD8+降低,CD3+、CD4+、Ig A水平均上升,差异均有统计学意义(P <0. 05);等离子组术后出血发生率低于传统手术组,差异有统计学意义(P <0. 05)。结论低温等离子系统联合腺样体扁桃体切除术治疗OSAHS患儿疗效较好,术后出血比例更低。
Objective To investigate the clinical efficacy and safety of low temperature plasma system combined with adenotonsillectomy in the treatment of sick children with obstructive sleep apnea hypopnea syndrome( OSAHS). Methods A total of 518 sick children with OSAHS were divided into traditional surgery group( n = 268) and plasma group( n = 250) according to the surgery methods.The traditional surgery group was given traditional adenotonsillectomy,and the plasma group was given low temperature plasma system combined with adenotonsillectomy.All patients were followed up for 6 months after operation.The perioperative related indexes,respiratory disorder indexes,minimum oxygen saturation,average oxygen saturation and T lymphocyte subset before and after 6 months of operation were compared between the two groups.The incidence rate of postoperative complications was also compared between the two groups.Results The hospital stay,operative time and intraoperative blood loss in the plasma group were shorter or less than those in the traditional surgery group( P < 0. 05).Compared with before operation,respiratory disorder indexes after operation were decreased in the two groups while the minimum oxygen saturation and average oxygen saturation were increased( P < 0. 05). CD8+level was decreased while levels of CD3+,Ig A and CD4+were increased( P < 0. 05).The incidence of postoperative bleeding in the plasma group was lower than that in the traditional surgery group( P < 0. 05).Conclusion Low temperature plasma system combined with adenotonsillectomy in the treatment of sick children with OSAHS has good efficacy and low proportion of postoperative bleeding.
Objective To investigate the clinical efficacy and safety of low temperature plasma system combined with adenotonsillectomy in the treatment of sick children with obstructive sleep apnea hypopnea syndrome( OSAHS). Methods A total of 518 sick children with OSAHS were divided into traditional surgery group( n = 268) and plasma group( n = 250) according to the surgery methods.The traditional surgery group was given traditional adenotonsillectomy,and the plasma group was given low temperature plasma system combined with adenotonsillectomy.All patients were followed up for 6 months after operation.The perioperative related indexes,respiratory disorder indexes,minimum oxygen saturation,average oxygen saturation and T lymphocyte subset before and after 6 months of operation were compared between the two groups.The incidence rate of postoperative complications was also compared between the two groups.Results The hospital stay,operative time and intraoperative blood loss in the plasma group were shorter or less than those in the traditional surgery group( P < 0. 05).Compared with before operation,respiratory disorder indexes after operation were decreased in the two groups while the minimum oxygen saturation and average oxygen saturation were increased( P < 0. 05). CD8+level was decreased while levels of CD3+,Ig A and CD4+were increased( P < 0. 05).The incidence of postoperative bleeding in the plasma group was lower than that in the traditional surgery group( P < 0. 05).Conclusion Low temperature plasma system combined with adenotonsillectomy in the treatment of sick children with OSAHS has good efficacy and low proportion of postoperative bleeding.
引文
[1]罗俊芳,蒋军广,杨超,等.阻塞性睡眠呼吸暂停低通气综合征患者日间嗜睡的相关因素[J].中国老年学杂志,2016,36(10):2425-2427.
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[4]Othman MN,Bee SG,Abdul LH.Impact of adenotonsillectomy on the quality of life in children with sleep disordered breathing[J]. International Journal of Pediatric Otorhinolaryngology,2016,91(3):105.
[5]周成勇,孙宝春,王丰,等.低温等离子辅助下儿童腺样体和扁桃体手术临床疗效观察[J].临床耳鼻咽喉头颈外科杂志,2016,30(11):863-866.
[6]中华耳鼻咽喉头颈外科杂志委员会.儿童阻塞性睡眠呼吸暂停低通气综合征诊疗指南草案(乌鲁木齐,2006)[J].中华耳鼻咽喉头颈外科杂志,2007,42(2):83-84.
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[8]Jr FR,Rosenfeld RM,Rao M.First place—resident clinical science award 1999. Quality of life for children with obstructive sleep apnea[J].Otolaryngology-Head and Neck Surgery,2000,123(1):9-16.
[9]Zhang Z,Wang C.Immune status of children with obstructive sleep apnea/hypopnea syndrome[J]. Pakistan Journal of Medical Sciences,2017,33(1):195-199.
[10]操金华,陈绪清,郑志刚,等.腺样体大小对儿童阻塞性睡眠呼吸暂停低通气综合征影响的研究[J].重庆医学,2017,46(31):4418-4420.
[11]磨宾宇,李纪辉,冯海燕,等.高频电刀扁桃体部分切除术与完全切除术治疗儿童OSHAS的中远期疗效对比[J].实用医学杂志,2017,33(21):3577-3581.
[12]刘学军,黄赛瑜,高金建,等.鼻内镜下低温等离子射频消融术治疗儿童鼾症的疗效及术后反应观察[J].中国内镜杂志,2016,22(6):5-8.
[13]左红霞,牛玉明,张超,等.我国低温等离子消融术与常规扁桃体剥离术临床疗效的Meta分析[J].临床耳鼻咽喉头颈外科杂志,2018,32(04):269-278.
[14]祝小莉,杨华,陈晓巍,等,低温等离子刀辅助下儿童扁桃体和腺样体切除术临床效果分析[J].临床耳鼻咽喉头颈外科杂志,2011,25(12):552.
[15]Pearl AJ,Manoukian JJ. Adenoidectomy:indirect visualization of choanal adenoids[J].J Otolaryngol,1994,23:221-224.
[16]李大伟,张庆丰,宋伟.低温等离子射频治疗儿童阻塞性睡眠呼吸暂停低通气综合征768例研究[J].临床耳鼻咽喉头颈外科杂志,2014,28(7):453-454.
[17]王桂香,何靖雅,张杰,等.儿童阻塞性睡眠呼吸暂停低通气综合征与炎症的关系[J].解放军医学杂志,2017,42(11):956-961.
[18]金书香,王吉喆,曲慧.腺样体、扁桃体切除术对OSAHS患儿免疫功能的影响[J].临床耳鼻咽喉头颈外科杂志,2017,31(23):1810-1814.
[2]Zhang J,Chen J,Yin Y,et al.Therapeutic effects of different drugs on obstructive sleep apnea/hypopnea syndrome in children[J]. World Journal of Pediatrics,2017,13(6):537-543.
[3]叶京英,李京京.浅谈儿童腺样体和扁桃体肥大[J].临床耳鼻咽喉头颈外科杂志,2016,30(6):449-451.
[4]Othman MN,Bee SG,Abdul LH.Impact of adenotonsillectomy on the quality of life in children with sleep disordered breathing[J]. International Journal of Pediatric Otorhinolaryngology,2016,91(3):105.
[5]周成勇,孙宝春,王丰,等.低温等离子辅助下儿童腺样体和扁桃体手术临床疗效观察[J].临床耳鼻咽喉头颈外科杂志,2016,30(11):863-866.
[6]中华耳鼻咽喉头颈外科杂志委员会.儿童阻塞性睡眠呼吸暂停低通气综合征诊疗指南草案(乌鲁木齐,2006)[J].中华耳鼻咽喉头颈外科杂志,2007,42(2):83-84.
[7]Sateia MJ.International classification of sleep disorders-third edition:highlights and modifications[J].Chest,2014,146:1387-1394.
[8]Jr FR,Rosenfeld RM,Rao M.First place—resident clinical science award 1999. Quality of life for children with obstructive sleep apnea[J].Otolaryngology-Head and Neck Surgery,2000,123(1):9-16.
[9]Zhang Z,Wang C.Immune status of children with obstructive sleep apnea/hypopnea syndrome[J]. Pakistan Journal of Medical Sciences,2017,33(1):195-199.
[10]操金华,陈绪清,郑志刚,等.腺样体大小对儿童阻塞性睡眠呼吸暂停低通气综合征影响的研究[J].重庆医学,2017,46(31):4418-4420.
[11]磨宾宇,李纪辉,冯海燕,等.高频电刀扁桃体部分切除术与完全切除术治疗儿童OSHAS的中远期疗效对比[J].实用医学杂志,2017,33(21):3577-3581.
[12]刘学军,黄赛瑜,高金建,等.鼻内镜下低温等离子射频消融术治疗儿童鼾症的疗效及术后反应观察[J].中国内镜杂志,2016,22(6):5-8.
[13]左红霞,牛玉明,张超,等.我国低温等离子消融术与常规扁桃体剥离术临床疗效的Meta分析[J].临床耳鼻咽喉头颈外科杂志,2018,32(04):269-278.
[14]祝小莉,杨华,陈晓巍,等,低温等离子刀辅助下儿童扁桃体和腺样体切除术临床效果分析[J].临床耳鼻咽喉头颈外科杂志,2011,25(12):552.
[15]Pearl AJ,Manoukian JJ. Adenoidectomy:indirect visualization of choanal adenoids[J].J Otolaryngol,1994,23:221-224.
[16]李大伟,张庆丰,宋伟.低温等离子射频治疗儿童阻塞性睡眠呼吸暂停低通气综合征768例研究[J].临床耳鼻咽喉头颈外科杂志,2014,28(7):453-454.
[17]王桂香,何靖雅,张杰,等.儿童阻塞性睡眠呼吸暂停低通气综合征与炎症的关系[J].解放军医学杂志,2017,42(11):956-961.
[18]金书香,王吉喆,曲慧.腺样体、扁桃体切除术对OSAHS患儿免疫功能的影响[J].临床耳鼻咽喉头颈外科杂志,2017,31(23):1810-1814.