摘要
目的 探究鼻内镜视角下低温等离子射频消融腺样体切除术对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿术后疼痛、通气功能及咽鼓管功能的影响.方法 回顾性选取2019年12月至2022年12月唐山市妇幼保健院收治的OSAHS患儿143例纳入研究.按照随机数字表法将其分为观察组(n=71)和对照组(n=72).观察组行鼻内镜直视下低温等离子射频消融腺样体切除术干预,对照组行鼻动力切割腺样体切除术干预.观察并比较两组患儿手术前及手术后2、8、24 h的疼痛行为量表[面部表情、下肢活动、整体活动、哭泣情况、安抚难度(FLACC)]评分,手术前及手术后6个月的呼吸道通气功能相关指标[呼吸紊乱指数(RDI)、氧减指数(ODI)、呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO2)]变化情况,咽鼓管功能,手术前及手术后6个月的生活质量[OSAHS特异性生活质量问卷(OSA-18)].结果 观察组手术后2、8、24 h的FLACC评分和对照组手术后24 h的FLACC评分均较手术前降低,且观察组手术后2、8 h的FLACC评分分别为(8.75±1.34)、(8.18±1.12)分,均低于对照组[(10.33±0.72)、(10.19±1.75)分],差异均有统计学意义(P＜0.05).手术后6个月,两组的RDI、ODI、AHI均较手术前降低,LSaO2均较手术前升高,且观察组的 RDI、ODI、AHI 分别为(2.18±0.62)次/min、(10.13±4.78)h、(19.42±4.22)次/min,均显著低于对照组[(3.97±0.75)次/min、(15.79±3.09)h、(24.72±5.32)次/min],LSaO2为(73.92±9.84)％,显著高于对照组[(54.13±9.98)％],差异均有统计学意义(P＜0.05).手术后6个月,观察组的最大鼓室压差值较手术前升高,两组的咽鼓管功能障碍发生率均较手术前降低,差异均有统计学意义(P＜0.05);观察组手术后6个月的最大鼓室压差值为(24.45±2.85)daPa,显著高于对照组[(14.97±2.79)daPa],咽鼓管功能障碍发生率为2.82％,低于对照组(12.50％),差异均有统计学意义(P＜0.05).手术后6个月,两组OSA-18评分均较手术前降低,且观察组手术后6个月的OSA-18评分为(38.75±5.24)分,低于对照组[(50.93±5.49)分],差异均有统计学意义(P＜0.05).结论 鼻内镜直视下低温等离子射频消融腺样体切除术治疗OSAHS患儿具有显著疗效,可有效减轻患儿术后疼痛,改善其通气功能、咽鼓管功能及生活质量.
Abstract
Objective To investigate the effect of low temperature plasma radiofrequency ablation adenoidectomy under nasal endoscopy on postoperative pain,ventilation function and eustachian tube function in children with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods A total of 143 children with OSAHS admitted to Tangshan Maternal and Child Health Hospital from December 2019 to December 2022 were retrospectively selected and included in the study.According to the random number table method,they were divided into the observation group(n=71)and the control group(n=72).The observation group underwent endoscopic adenoidectomy with low temperature plasma radio-frequency ablation,while the control group underwent nasal dynamic adenoidectomy.The scores of pain behavior scale[facial expression,lower limb activity,overall activity,crying,FLACC]before operation and 2,8,24 h after operation,the changes of respiratory ventilation function re-lated indexes[respiratory distur-bance index(RDI),oxygen desaturation index(ODI),apnea-hypopnea index(AHI),lowest oxygen satura-tion(LSaO2)]before operation and 6 months after operation,eustachian tube function,quality of life before operation and 6 months after opera-tion[OSAHS specific quality of life questionnaire(OSA-18)]were observed and compared between the two groups.Results The FLACC scores of the observation group at 2,8 and 24 h after operation and the FLACC scores of the control group at 24 h after operation were lower than those before operation,and the FLACC scores of the observation group at 2 and 8 h after operation were(8.75±1.34)and(8.18±1.12)points,respectively,which were lower than those of the control group[(10.33±0.72)and(10.19±1.75)points],the differences were statis-tically significant(P＜0.05).At 6 months after operation,the RDI,ODI and AHI of the two groups were lower than those before operation,and the LSaO2 was higher than that before operation,the RDI,ODI and AHI of the observation group were(2.18±0.62)times/min,(10.13±4.78)h and(19.42±4.22)times/min,respectively,which were significantly lower than those of the control group[(3.97±0.75)times/min,(15.79±3.09)h,(24.72±5.32)times/min],and the LSaO2 was(73.92±9.84)％,which was significantly higher than that of the control group[(54.13±9.98)％],and the differences were statistically significant(P＜0.05).At 6 months after operation,the maximum tympanic pressure difference in the observation group was higher than that before operation,and the incidence of eustachian tube dysfunction in the two groups was lower than that before operation,the maximum tympanic pressure difference in the observation group was(24.45±2.85)daPa,which was significantly higher than that in the control group[(14.97±2.79)daPa],and the incidence of eustachian tube dysfunction was 2.82％,which was lower than that in the control group(12.50％),the differences were statistically significant(P＜0.05).At 6 months after operation,the OSA-18 scores of the two groups were lower than those before operation,and the OSA-18 score of the observation group at 6 months after op-eration was(38.75±5.24)points,which was lower than that of the control group[(50.93±5.49)points],the differences were statistically significant(P＜0.05).Conclusion Low temperature plasma radiofrequency ablation adenoidectomy under nasal endoscopic direct vision has a significant effect on the treatment of OSAHS children,which can effectively reduce postoperative pain and improve their ventilation function,eusta-chian tube function and quality of life in children.
NETL
NSTL
万方数据