腺样体联合扁桃体切除术对 OSAHS 患儿睡眠质量的影响

Influence of Adenoidectomy Combined with Tonsillectomy on Sleep Quality of Children with OSAHS

摘要:

〔摘 要〕 目的：探讨腺样体联合扁桃体切除术对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿睡眠质量的影响。 方法：选取郑州儿童医院 2021 年 1 月至 2022 年 7 月收治的 98 例 OSAHS 患儿，随机分为对照组和观察组，各 49 例。 对照组采用单纯腺样体切除术，观察组采用腺样体联合扁桃体切除术。比较两组患儿治疗后临床疗效、手术前后呼吸暂 停通气指数（AHI）、阻塞性呼吸暂停指数（OAI）、最低血氧饱和度（LSaO2）水平变化、睡眠质量及 OSAHS 对生活质 量的影响程度，并统计 6 个月内并发症情况。 结果：治疗后观察组患儿临床总有效率高于对照组，差异具有统计学意义 （P ＜ 0.05）。与术前比较，出院时两组患儿 AHI 及 OAI 水平均降低，且观察组患儿 AHI 及 OAI 水平均低于对照组，差 异具有统计学意义（P ＜ 0.05）；出院时两组患儿 LSaO2 水平均明显高于术前，差异具有统计学意义（P ＜ 0.05），但组 间 LSaO2 水平比较，差异无统计学意义（P ＞ 0.05）。与术前比较，出院时两组患儿匹茨堡睡眠质量指数量表（PSQI）评 分、Epworth 嗜睡量表（ESS）评分及儿童 OSAHS 疾病特异性生活质量调查量表（OSA–18）评分均降低，且观察组患儿 PSQI、ESS 及 OSA–18 评分均低于对照组，差异具有统计学意义（P ＜ 0.05）。术后 6 个月内，观察组患儿并发症发生率 低于对照组，差异具有统计学意义（P ＜ 0.05）。 结论：腺样体联合扁桃体切除术可更有效地降低 OSAHS 患儿 AHI、OAI 水平，改善其睡眠、生活质量，降低术后扁桃体再度增生及扁桃体反复发炎风险，整体临床疗效优于单纯腺样体切除术， 对于腺样体和扁桃体肥大的患儿，建议同时切除腺样体和扁桃体。

Abstract:

〔Abstract〕 Objective To investigate the influence of adenoidectomy combined with tonsillectomy on sleep quality in children with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods 98 children with OSAHS who were treated in Zhengzhou children's hospital from January 2021 to July 2022 were selected and randomly divided into a control group and an observation group, 49 cases in each group. The control group was treated with simple adenoidectomy, while the observation group was treated with adenoidectomy combined with tonsillectomy. The clinical efficacy after posttreatment, levels changes of apnea-hypopnea index (AHI), obstructive sleep apnea index (OAI) and lowest oxygen saturation (LSaO2), sleep quality and the impact of OSAHS on the quality of life before and after operation were compared between the two groups, the complications within 6 months were counted. Results The clinical treatment efficiency of the observation group after treatment was higher than that of the control group, and the difference was statistically significant (P < 0.05). Compared with preoperative, the levels of AHI and OAI at discharge in both groups decreased, and the AHI and OAI levels in the observation group were lower than those in the control group, the differences were statistically significant (P < 0.05); the LSaO2 levels at discharge in both groups were significantly higher than that before operation, the differences were statistically significant (P < 0.05), but there was no statistically significant difference in LSaO2 levels between the groups (P > 0.05). Compared with preoperative, the scores of Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS) and children OSAHS specific quality of life questionnaire (OSA-18) at discharge in both groups decreased, and the scores of PSQI, ESS and OSA-18 in the observation group were lower than those of the control group, the differences were statistically significant (P < 0.05). The incidence of complications within 6 months after operation in the observation group was lower than that in the control group, and the difference was statistically significant (P < 0.05). Conclusion The adenoidectomy combined with tonsillectomy can more effectively reduce AHI and OAI in children with OSAHS, improve their sleep and quality of life, and reduce the risk of postoperative tonsil re proliferation and recurrent inflammation, the overall clinical efficacy is better than simple adenoidectomy. It is recommended to remove both adenoids and tonsils simultaneously for children with adenoid and tonsil hypertrophy.