腺样体肥大对儿童青少年颅颌面形态及呼吸功能的影响

发布时间：2018-04-17 06:47

  本文选题：上气道 + 腺样体肥大　； 参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]本课题以50名具有明显颅颌面畸形伴腺样体肥大并处于发育高峰前期或高峰期的患儿作为研究对象,采用X线头颅侧位片、电子鼻咽喉镜、便携式多导睡眠监测仪,观测该类患儿颅颌面、气道形态特征;通过对患儿呼吸功能的分析,研究电子鼻咽镜和X线头颅侧位片对腺样体肥大判别的差异性;探究三种检查手段诊断腺样体肥大对颅面形态及呼吸功能影响的方法,为多学科联合诊断、治疗错鄈畸形伴腺样体肥大患儿提供有效的治疗途径。[方法]以具有明显颅颌面畸形伴腺样体肥大并处于发育高峰前期或高峰期的患儿作为研究对象。对患儿的年龄、性别、体重、睡眠呼吸状态等信息进行分析。通过临床检查对患儿的牙弓宽度、腭盖高度等信息进行分析。分别采用X线头颅侧位片(A/N值)和电子鼻咽镜对腺样体肥大进行判别,根据两者的差异将50名患儿分为两组:T1组(腺样体占后鼻孔范围50%); T2组(腺样体占后鼻孔范围20%)。对38项指标进行测量后,采用SPSS22.0统计学软件对颅颌面、上气道各测量数据进行分析,比较两组颅颌面、气道测量指标和呼吸功能是否存在差异。[结果]1、研究患儿50例,男28例,女22例:年龄8～13岁,不同患儿具有不同的错鄈畸形表现,以骨性Ⅱ类31人(占62%)居多、骨性Ⅰ类12人(占38%)、骨性Ⅲ类7人(占]4%);高角(MP-FH30.5°) 40人、均角(23.5°≤MP-FH≤30.5°) 8 人、低角(MP-FH23.5°) 2 人。患儿临床表现:长窄面型有38人;牙弓狭窄、腭盖高拱有39人;鼻孔较小28人;睡眠打鼾25人;夜间张口呼吸34人;无家族遗传史37人。2、根据昆明医科大学附属医院耳鼻喉科鼻咽镜检查报告将患儿分组:T1 (腺样体占后鼻孔范围50%)、T2 (腺样体占后鼻孔范围≥50%),通过比较两组患儿颅颌面、气道测量值,除PNS-ad2差异有明显统计学意义(P0.01)外,其他测量值均无统计学意义。3、50名患儿均通过便携式睡眠检测仪检查,结果显示:T1组中18人均存在呼吸功能异常,以低通气(OHI5有27人,占94.7%)为主,仅有1人呼吸功能正常(AHI=0,占5.2%); T2组中29人存在呼吸功能异常,其中有2人(占6.4%)诊断为儿童OSAHS,有2人呼吸功能正常(AHI=0,占6.4%)。[结论]1、处在生长发育期的青少年,因腺样体肥大造成上呼吸道阻塞引发口呼吸,将对其颅颌面和上气道形态产生影响,其中以II类高角骨面型居多。2、X线头颅侧位片、电子鼻咽镜和便携式睡眠检测仪是评价儿童腺样体肥大和呼吸功能异常的常用手段,但临床中X线头颅侧位片和电子鼻咽镜对腺样体肥大诊断存在差异。3、本研究采用便携式PSG对患儿呼吸功能进行分析,为错鄈畸形伴腺样体肥大患儿的有效诊治提供科学依据。
[Abstract]:[objective] in this study, 50 children with craniomaxillofacial malformation with adenoid hypertrophy and in the prepeak or peak period of development were studied, and lateral radiographs, electronic nose and throat endoscopy, and portable polysomnography were used.The morphological characteristics of craniomaxillofacial and airway were observed, and the difference between electronic nasopharyngoscope and X-ray lateral radiographs on adenoid hypertrophy was studied by analyzing the respiratory function of the children.To explore three methods to diagnose the effect of adenoid hypertrophy on craniofacial morphology and respiratory function, and to provide an effective treatment approach for children with malformation and adenoid hypertrophy.[methods] Children with craniomaxillofacial malformation and adenoid hypertrophy were studied.The age, sex, body weight and sleep breathing status of the children were analyzed.The width of dental arch and height of palatal lid were analyzed by clinical examination.Adenoid hypertrophy was judged by X ray lateral cephalograms (A / N) and electronic nasopharyngoscope. According to the difference, 50 children were divided into two groups: group T 1 (adenoid occupied the area of posterior nostril, 50%) and group T2 (adenoid, area of posterior nostril, 20%).After 38 items were measured, the data of craniomaxillofacial and upper airway were analyzed by SPSS22.0 software, and the difference of airway measurement index and respiratory function between the two groups was compared.[results] 1. There were 50 children (28 males and 22 females) in the study, aged 813 years. Different children had different malformation. Most of them were bone type 鈪，

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