学龄前睡眠呼吸暂停综合征患儿手术后生活质量调查研究

发布时间：2018-04-26 15:39

本文选题：睡眠呼吸暂停综合征 + 阻塞性　；参考：《山东大学》2017年硕士论文

【摘要】：研究背景:儿童阻塞性睡眠呼吸暂停综合征(OSAS)是指睡眠时上气道反复发生部分或全部塌陷阻塞而导致的通气不足和呼吸暂停,是一种以睡眠期上气道塌陷为特征的呼吸障碍,患病率为1-3%。诊断基于临床症状,体格检查和睡眠研究。多导睡眠图(PSG)是确定OSAS的存在和严重程度的金标准。肥大的腺样体和扁桃体是儿童OSAS的主要原因。常规扁桃体和腺样体切除术(TA)因此被广泛认为是儿童睡眠呼吸暂停综合征的有效的一线治疗。儿童阻塞性睡眠呼吸暂停综合征对生活质量的影响最近开始引起越来越多的研究关注。儿童OSAS可引起生长发育迟缓、认知功能障碍、性格改变及行为异常等,甚至并发肺源性心脏病等呼吸、循环系统病变,是最常见的儿童睡眠障碍性疾病。测量儿童的生活质量需要使用自我或护理人员管理的仪器来量化对情绪状态,身体症状和家庭相互作用的影响。在生活质量测量中,阻塞性睡眠呼吸暂停综合征18项生活质量调查表(OSA-18)是一种广泛应用于儿科阻塞性睡眠障碍的疾病特异性工具。相关研究发现儿童OSAS对生活质量有显著影响。此外,OSAS儿童在常规扁桃体和腺样体切除术后获得了显著的短期和长期生活质量改善,如OSA-18评分的变化。本研究阐明了 OSAS儿童扁桃体腺样体切除术后的短期和长期生活质量结果,判断手术后生活质量的变化情况。目的:评估阻塞性睡眠呼吸暂停综合征(OSAS)儿童扁桃体腺样体切除术治疗的患儿,术前、术后6个月(术后近期)和术后3年(术后中期)的生活质量的变化。方法:选取2012年1月至2014年1月,在齐鲁医院就诊的首要症状为睡眠时打鼾或张口呼吸的符合儿童OSAHS诊疗指南中的诊断标准的患儿120例,男78例,女42例。所有受试者都有临床症状,并接受扁桃体腺样体切除术治疗。患儿的护理人员被要求在手术前、手术后6个月内(短期)和手术后3年(中期)完成OSA-18调查。结果:共包括120名儿童(平均年龄为4.9± 1.3岁;65%患儿为男孩)。符合入选标准的儿童均进行了扁桃体腺样体切除术。儿童的监护人被要求在手术前、手术后6个月和手术后3年分别完成OSA-18生活质量。使用配对t检验比较来自术前和术后调查的评分。手术前平均OSA-18总分为70.4±15.1。手术后 6 个月(40.2±12.7,p0.001)和术后 3 年(42.2±13.9,p0.001)平均OSA-18总分显着降低。OSA-18五项分值分别在术后6个月和术后3年的分值在术后随访期间也显着减少(p0.001)。比较术后6个月和术后3年的平均OSA-18总分结果可见,睡眠障碍分数,情绪困扰分数,白天功能分数和护理者关注分数在术后6个月和术后3年之间没有显着差异,而身体不适症状分数在术后6个月和术后3年存在统计学意义的显著差异(8.6±2.9对比9.8±3.5,p= 0.02)。结论:扁桃体腺样体切除术作为OSAS的标准治疗可以显著提高OSAS儿童的生活质量,而且患儿的短期生活质量和中期生活质量都可以得到改善。
[Abstract]:Background: obstructive sleep apnea syndrome (OSAS) is a respiratory disorder characterized by the collapse of the upper airway during sleep, which is caused by repeated partial or total collapse of the upper airway. The prevalence rate was 1-3. Diagnosis is based on clinical symptoms, physical examination and sleep studies. Polysomnography (PSG) is the gold standard for determining the existence and severity of OSAS. Hypertrophy of adenoids and tonsils is the main cause of OSAS in children. Conventional tonsillectomies and adenoidectomy (TAA) are therefore widely regarded as an effective first-line treatment for sleep apnea syndrome in children. The effects of obstructive sleep apnea syndrome (OSAS) on quality of life in children have recently begun to attract more and more attention. Children OSAS can cause growth retardation, cognitive dysfunction, personality change and behavioral abnormality, even accompanied by pulmonary heart disease and other respiratory and circulatory diseases, is the most common sleep disorders in children. Measuring children's quality of life requires the use of self-administered or career-managed instruments to quantify the effects on emotional states, physical symptoms, and family interactions. OSA-18 is a disease specific tool widely used in pediatric obstructive sleep disorders. Related studies have found that children with OSAS have a significant impact on quality of life. In addition, there were significant short-term and long-term quality of life improvements in children with OSAS after routine tonsillectomy and adenoidectomy, such as changes in OSA-18 scores. The results of short and long term quality of life (QOL) after tonsillectomy in children with OSAS were elucidated and the changes of quality of life (QOL) were evaluated. Objective: to evaluate the changes of quality of life (QOL) in children with obstructive sleep apnea syndrome (OSAS) treated by adenoidectomy before, 6 months and 3 years after operation. Methods: from January 2012 to January 2014, 120 children (78 males and 42 females) who met the diagnostic criteria in OSAHS guidelines for diagnosis and treatment during sleep snoring or breathing with open mouth were selected in Qilu Hospital. All subjects had clinical symptoms and underwent tonsillectomy. Nursing staff were asked to complete the OSA-18 survey before surgery, within 6 months (short term) and 3 years (mid-term) after surgery. Results: a total of 120 children (mean age 4.9 卤1.3 years old, 65%) were boys. All children who met the inclusion criteria underwent tonsillectomy. The child's guardian was asked to complete OSA-18 before surgery, 6 months after surgery and 3 years after surgery. A paired t test was used to compare scores from preoperative and postoperative surveys. The average total score of OSA-18 before operation was 70.4 卤15.1. The mean total score of OSA-18 decreased significantly at 6 months after operation (40.2 卤12.7p0.001) and 3 years after operation (42.2 卤13.9p0.001). The five scores of OSA-18 were also significantly decreased during the follow-up period of 6 months and 3 years after operation respectively. Compared with the average OSA-18 scores of 6 months and 3 years after operation there was no significant difference in the scores of sleep disturbance emotional disturbance daytime function and nursing care between 6 months and 3 years after operation. However, there was a significant difference in the score of physical discomfort between 6 months after operation and 3 years after operation (8.6 卤2.9 vs 9.8 卤3.5, p = 0.02). Conclusion: tonsillectomy as the standard treatment of OSAS can significantly improve the quality of life of children with OSAS, and the short-term and medium-term quality of life of children with OSAS can be improved.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R766

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