Cohen S R, Suzman K, Simms C, Burstein F D, Riski J, Montgomery G
Center for Craniofacial Disorders, Division of Pediatric Pulmonary Medicine, Scottish Rite Children's Medical Center, Atlanta, GA, USA.
Plast Reconstr Surg. 1998 Nov;102(6):1855-64. doi: 10.1097/00006534-199811000-00008.
Successful surgery for medically refractory obstructive sleep apnea in children has prevented tracheostomy in many cases. However, sleep apnea surgery requires postoperative ventilatory support and intensive care, and the magnitude of the surgery may be substantial. Tracheostomy, in contrast, is a simple procedure that is considered the standard of care for relief of upper airway obstruction. To determine their relative benefits, the posttreatment quality of life in children with airway obstruction who underwent either sleep apnea surgery or tracheostomy was evaluated and compared in this exploratory study. A 76-item questionnaire was developed to assess the quality of life in this population, including an investigation of physical symptoms, psychosocial function, and costs. Forty-four parent questionnaires were returned; 16 of these parents had children who had had clinically successful sleep apnea surgery and 6 had children who had had tracheostomies placed for obstructive sleep apnea. Results revealed that the parents of children in the tracheostomy group ranked 95 percent of all items on the questionnaire as worse than the parents of children in the surgery group. These rankings included statistically significant group differences (p < 0.05) on number of hospital, emergency room, and physician visits, and hours per day spent on their child's respiratory care. In addition, parents of the successful sleep apnea surgery group reported significant improvement (p < 0.05) in 100 percent of symptom variables (i.e., choking, snoring, and daytime sleepiness), 75 percent of parental care variables (i.e., assisting with their child's breathing, suctioning), 67 percent of medical visit items, and 75 percent of the stress and coping variables (i.e., perception of child's distress, worrying about their child's breathing, level of family stress), indicating substantial gains in quality of life. Despite initially higher costs, successful surgery for obstructive sleep apnea was associated with substantial benefits in quality of life, health, and psychosocial outcomes when compared with tracheostomy.
成功实施手术治疗儿童难治性阻塞性睡眠呼吸暂停在许多情况下避免了气管切开术。然而，睡眠呼吸暂停手术术后需要通气支持和重症监护，而且手术规模可能很大。相比之下，气管切开术是一种简单的手术，被认为是缓解上气道阻塞的标准治疗方法。为了确定它们的相对益处，在这项探索性研究中，对接受睡眠呼吸暂停手术或气管切开术的气道阻塞儿童的治疗后生活质量进行了评估和比较。设计了一份包含76个条目的问卷来评估该人群的生活质量，包括对身体症状、心理社会功能和费用的调查。共收回44份家长问卷；其中16位家长的孩子接受了临床上成功的睡眠呼吸暂停手术，6位家长的孩子因阻塞性睡眠呼吸暂停接受了气管切开术。结果显示，气管切开术组儿童的家长将问卷上所有条目的95% 评为比手术组儿童的家长情况更差。这些排名包括在住院次数、急诊室就诊次数、看医生次数以及每天花在孩子呼吸护理上的时间方面具有统计学意义的组间差异（p < 0.05）。此外，成功的睡眠呼吸暂停手术组的家长报告，100% 的症状变量（即窒息、打鼾和日间嗜睡）、75% 的家长护理变量（即协助孩子呼吸、吸痰）、67% 的医疗就诊项目以及75% 的压力和应对变量（即对孩子痛苦的感知、对孩子呼吸的担忧、家庭压力水平）有显著改善（p < 0.05），表明生活质量有显著提高。尽管阻塞性睡眠呼吸暂停手术最初费用较高，但与气管切开术相比，成功实施该手术在生活质量、健康和心理社会结果方面带来了显著益处。
