摘要目的 探讨无创通气在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿外科治疗中的应用.方法 2002年5月至2007年12月经多道睡眠监测(PSG)诊断为OSAHS的11例腺样体扁桃体肥大患儿和7例曾行腺样体扁桃体切除术后的患儿应用无创通气治疗,其中男17例,女1例;年龄1～11岁,中位数3.8岁.所有患儿应用无创通气治疗后再次行PSG.统计数据符合正态分布以x-±s表示,治疗前后的呼吸参数变化采用配对t检验.结果 11例术前使用鼻持续正压通气(nasal continuous positive airway pressuren,nCPAP)患儿,术中无麻醉并发症及术后拔管困难,其中6例腺样体扁桃体切除术后呼吸暂停低通气指数(AHI)＜10次/h,最低脉氧饱和度(pulse oxygen saturation,SpO_2)＞0.85,无需再行无创通气治疗;5例术后围手术期仍使用nCPAP治疗.1例本院患儿及7例外院术后疗效不佳患儿术后长期使用nCPAP治疗.经nCPAP治疗前和治疗时的睡眠呼吸暂停低通气指数、最低SpO_2及SpO_2低于0.90占睡眠时间的百分比分别为(4.7±3.9)次/h、0.867±0.069和0.3%±0.5%,与治疗前(77.6±39.8)次/h、0.535±0.151和46.9%±34.5%相比有显著改善(t值分别为7.77、-11.62、5.69,P值均＜0.001).结论 无创通气是重度OSAHS患儿围手术期可选择的一种有效治疗方法,手术后仍有阻塞性睡眠呼吸暂停的患儿,nCPAP治疗效果良好.对家庭nCPAP治疗的患儿要定期进行随访.

abstractsObjective To study the efficacy of noninvasive ventilation in the surgical treatment of obstructive sleep apnea hypopnea syndrome(OSAHS)in children.Methods Since 2002.5-2007.12,eleven children with adenotonsillar hypertrophy and seven children with post-adenoidtonsillectomy were enrolled in the study.All children were confirmed as OSAHS by polysomnography(PSG)or portable oximetry monitor.Male:female ratio was 17:1.The age ranged from 1 to 11 years(median 3.8 years).The noninvasive ventilation treatment was carried out in all children pre-or postoperatively.PSG was the index for therapy effect.SPSS 11.5 was used to analyse the data.The parameters,x±s,were normal distribution,and paired t-test for significancy.A P valBe of＜0.05 was considered statistically significant.Results Six children after adenotosillectomy,with AHI＜10/h,lowest pulse oxygen saturation(SpO_2)＞0.85,did not need nasal continuous positive airway pressure(nCPAP).Eleven patients with preoperative nCPAP,did not have anesthesia comlications.Post-nCPAP,apnea and hypopnea index AHI(4.7±3.9)/h,the lowest SpO_2 0.867±0.069,and the average time percents SpO_2＜0.90 during sleep(0.3%±0.5%)improved significantly compared to pre-nasal continuous positive airway pressurecn(nCPAP),which were(77.6±39.8)/h,(0.535±0.151)and(46.9%±34.5%),t value were 7.77,-11.62,5.69,P＜0.001.Conclusions Noninvasive ventilation is an effective treatment for severe OSAHS children pre-or postoperation.nCPAP could be used to treat children still with OSAHS after adenotonsillectomy,and also an effective treatment to the ones who had surgical contraindication.Regular follow-up should be done for patients with nCPAP at home.