电动扁桃体切除术治疗儿童重度阻塞性睡眠呼吸暂停的疗效。
Effectiveness of Powered Intracapsular Tonsillectomy in Children With Severe Obstructive Sleep Apnea.
机构信息
Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
Office of Health Equity and Inclusion, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware.
出版信息
JAMA Otolaryngol Head Neck Surg. 2016 Feb;142(2):150-6. doi: 10.1001/jamaoto.2015.3126.
IMPORTANCE
Powered intracapsular tonsillectomy and adenoidectomy (PITA) is an increasingly common pediatric procedure. Few studies have examined its effectiveness in children with severe obstructive sleep apnea (OSA).
OBJECTIVE
To assess the effectiveness of PITA in patients with severe OSA as evidenced by change in polysomnographic parameters.
DESIGN, SETTING, AND PARTICIPANTS: We performed a case series study with medical record review of 70 children with severe OSA who underwent PITA at a tertiary care pediatric hospital from January 1, 2010, through December 31, 2014.
MAIN OUTCOMES AND MEASURES
Preoperative and postoperative polysomnographic parameters.
RESULTS
Of the 70 children with severe OSA who underwent PITA, 39 (56%) were boys, and the median age at surgery was 3.7 years. There were significant mean (SD) decreases in the postoperative apnea-hypopnea index (32.4 [28.4] vs 5.8 [9.7], P < .001), obstructive apnea index (20.4 [17.97] vs 2.55 [5.9]), obstructive apnea-hypopnea index (25.5 [22.4] vs 3.9 [7.3], P < .001), arousal index (53.7 [33.9] vs 27.4 [22.6], P < .001), percentage of total sleep time spent snoring (28.6 [30.5] vs 13.6 [20.8], P = .001), and oxygen desaturation index of 4% or more (22.9 [26.4] vs 4.5 [9.9], P < .001). Mean (SD) oxygen saturation (96.8 [2.0] vs 98.2 [1.3], P < .001) and oxygen saturation nadir (75.5 [13.1] vs 88.4 [8.1], P < .001) increased significantly. A significant decrease in time was observed with an end-tidal carbon dioxide greater than 55 mm Hg (49.67 [97.5] vs 19.1 [73.9] minutes, P = .01).
CONCLUSIONS AND RELEVANCE
Powered intracapsular tonsillectomy and adenoidectomy improved OSA in this series of pediatric patients by reducing obstructive apneas and hypopneas, oxygen desaturation, arousal index, carbon dioxide level, and snoring, as well as increasing oxygen saturation nadir. Results are comparable to those described for traditional electrocautery tonsillectomy and support the use of PITA for the treatment of severe OSA in children with adenotonsillar hypertrophy.
重要性
经皮扁桃体切除术和腺样体切除术（PITA）是一种越来越常见的儿科手术。很少有研究探讨其在严重阻塞性睡眠呼吸暂停（OSA）儿童中的有效性。
目的
评估 PITA 在严重 OSA 患者中的有效性，证据为睡眠多导图参数的变化。
设计、地点和参与者：我们进行了一项病例系列研究，对 2010 年 1 月 1 日至 2014 年 12 月 31 日在一家三级儿科医院接受 PITA 的 70 名严重 OSA 儿童的病历进行了回顾性分析。
主要结局和测量指标
术前和术后睡眠多导图参数。
结果
在接受 PITA 的 70 名严重 OSA 儿童中，39 名（56%）为男孩，手术时的中位年龄为 3.7 岁。术后呼吸暂停-低通气指数（32.4[28.4] 与 5.8[9.7]，P<0.001）、阻塞性呼吸暂停指数（20.4[17.97] 与 2.55[5.9]）、阻塞性呼吸暂停-低通气指数（25.5[22.4] 与 3.9[7.3]，P<0.001）、觉醒指数（53.7[33.9] 与 27.4[22.6]，P<0.001）、总睡眠时间打鼾百分比（28.6[30.5] 与 13.6[20.8]，P=0.001）和 4%以上的氧减饱和度指数（22.9[26.4] 与 4.5[9.9]，P<0.001）均显著下降。平均（SD）氧饱和度（96.8[2.0] 与 98.2[1.3]，P<0.001）和氧饱和度最低点（75.5[13.1] 与 88.4[8.1]，P<0.001）显著增加。观察到呼气末二氧化碳大于 55mmHg 的时间显著减少（49.67[97.5] 与 19.1[73.9] 分钟，P=0.01）。
结论和相关性
在这一系列儿科患者中，经皮扁桃体切除术和腺样体切除术通过减少阻塞性呼吸暂停和低通气、氧减饱和度、觉醒指数、二氧化碳水平和打鼾，以及增加氧饱和度最低点，改善了 OSA。结果与传统电切扁桃体切除术相似，支持使用 PITA 治疗儿童腺样体扁桃体肥大引起的严重 OSA。
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