脑瘫合并阻塞性睡眠呼吸暂停儿童腺样体扁桃体切除术的风险和获益：系统评价。
Risks and Benefits of Adenotonsillectomy in Children With Cerebral Palsy With Obstructive Sleep Apnea: A Systematic Review.
机构信息
Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Critical Care Medicine, The Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
出版信息
Laryngoscope. 2022 Mar;132(3):687-694. doi: 10.1002/lary.29625. Epub 2021 May 25.
OBJECTIVES/HYPOTHESIS: Assess the risks and benefits of adenotonsillectomy (AT) for obstructive sleep apnea (OSA) in children with cerebral palsy (CP).
STUDY DESIGN
Systematic review.
METHODS
We conducted a systematic review of Medline, Embase, and Cochrane Central Registry from 1946 to 2021. Broad search concepts included cerebral palsy, pediatric, tonsillectomy/adenoidectomy, and sleep. Additional articles were identified by searching reference lists. Studies on the safety and efficacy of AT for OSA management in children with CP were included.
RESULTS
Fifteen articles met inclusion criteria. Articles were classified into one or more of four themes: intraoperative risk (n = 1), postoperative risk (n = 3), postoperative care requirements (n = 6), and surgical outcomes (n = 7). No intraoperative anesthetic complications were reported. Postoperatively, respiratory complications including pneumonia were common and necessitated additional airway management. Following AT, children with CP required close postoperative observation, experienced increased lengths of stay, and had increased odds of unplanned intensive care unit (ICU) admission. Benefits following AT were improvement in OSA as measured by a reduction in obstructive apnea-hypopnea index (OAHI) as well as improved quality of life in some; however, many patients went on to require tracheostomy due to persistent OSA.
CONCLUSIONS
Children with CP who undergo AT have a significant risk of developing a postoperative respiratory complication. Realistic counseling of families around increased perioperative risks in this population is imperative and close postoperative monitoring is critical. Many children will obtain a reduction in OAHI, but additional surgical management is often required, including tracheostomy. Further research is needed to determine the best management strategy for OSA in children with CP. Laryngoscope, 132:687-694, 2022.
目的/假设：评估脑瘫（CP）儿童腺样体扁桃体切除术（AT）治疗阻塞性睡眠呼吸暂停（OSA）的风险和益处。
研究设计
系统评价。
方法
我们对 1946 年至 2021 年期间的 Medline、Embase 和 Cochrane 中央登记处进行了系统检索。广泛的搜索概念包括脑瘫、儿科、扁桃体切除术/腺样体切除术和睡眠。通过搜索参考文献列表确定了其他文章。纳入了关于 CP 儿童 OSA 管理中 AT 的安全性和疗效的研究。
结果
15 篇文章符合纳入标准。文章分为四个主题之一或多个主题：术中风险（n=1）、术后风险（n=3）、术后护理要求（n=6）和手术结果（n=7）。没有报告术中麻醉并发症。术后，包括肺炎在内的呼吸道并发症很常见，需要额外的气道管理。行 AT 后，CP 患儿需要密切术后观察，住院时间延长，且计划外入住重症监护病房（ICU）的几率增加。AT 后，许多患者因持续的 OSA 而需要进行气管切开术，因此 CP 患儿的 OSA 得到了改善，这可以通过阻塞性睡眠呼吸暂停低通气指数（OAHI）的降低来衡量，且一些患者的生活质量也得到了改善。
结论
行 AT 的 CP 患儿发生术后呼吸并发症的风险显著增加。对该人群围手术期风险进行现实的咨询至关重要，术后密切监测也至关重要。许多患儿的 OAHI 会降低，但通常需要额外的手术治疗，包括气管切开术。需要进一步研究以确定 CP 儿童 OSA 的最佳管理策略。《喉镜》，132：687-694，2022。
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