手术联合舌下含服免疫治疗伴过敏性鼻炎的OSAHS儿童病例对照研究

发布时间：2018-06-12 14:12

本文选题：阻塞性睡眠呼吸暂停低通气综合征 + 变应性鼻炎　；参考：《安徽医科大学》2016年硕士论文

【摘要】：背景阻塞性睡眠呼吸暂停低通气综合征(Obstructive Sleep Apnea-hypopnea Syndrome,OSAHS)是指系上气道部分或完全梗阻,气道阻力增高影响睡眠中的呼吸过程,引起睡眠质量的下降,继发多系统损害疾病综合征。任何年龄阶段的人都可能出现,且病情严重程度各异。儿童正处于生长发育的关键时期,故对儿童而言,影响较为深远,可造成患儿生长发育落后、肺源性心脏病,听力受到影响,如耳鸣,耳闷,听力下降等,颌面部畸形等多种严重并发症。随着儿童OSAHS患病率越来越多,家长及临床医生的注意力也逐渐被吸引。国内大部分研究均着眼于手术方法的改进,本研究受部分患儿术后症状反复的启发,对伴过敏性鼻炎(allergic thinitis,AR)的鼾症患儿给予手术联合粉尘螨舌下含服脱敏治疗(sublingual immunotherapy,SLIT)。目的对两组伴AR的OSAHS儿童分别采用手术联合SLIT与单纯手术治疗,通过比较各自的治疗疗效,探讨SLIT对伴AR的OSAHS儿童术后打鼾症状转归的影响。方法选取2012年1月-2014年4月伴AR的OSAHS儿童60例,所有患儿粉尘螨皮肤点刺实试验结果均为“+++”或“++++”,随机分成两组:实验组(30例)采用手术联合SLIT治疗,对照组(30例)单纯采用手术治疗,手术治疗均为双侧腭扁桃体切除和增殖体切除术,实验组患儿手术后第1月后开始加行粉尘螨SLIT。对两组患儿术后第1月、第7月、第13月及第19月均采用OSA-18评分表及TNSS评分表对其睡眠打鼾症状(打鼾、张口呼吸、呼吸暂停、反复觉醒等)及鼻部症状(间断性鼻塞、喷嚏、鼻痒、流清涕)进行评分,运用统计分析的方法,分别比较各组患儿治疗前后评分变化及治疗前后两组患儿评分之间的差异。结果手术治疗前两组患儿睡眠打鼾评分及鼻炎症状评分,差异均无统计学意义(P0.05);手术后第1月较手术前相比,各组患儿打鼾症状及鼻部症状评分,差异均有统计学意义(P0.05);实验组患儿脱敏治疗后第6月及12月打鼾及鼻部症状评分较手术后第1月均明显下降;脱敏后第18月与第12月相比,差异无统计学意义:对照组患儿,术后第7月、13月及19月的打鼾症状与术后第1月相比,均明显增高,而鼻部症状评分术后第7月、13月及19月与术后第1月相比差异无显著意义。结论手术联合SLIT治疗可明显改善儿童打鼾及AR相关症状,增加手术疗效,减少术后复发。
[Abstract]:Background obstructive sleep apnea hypopnea syndrome (OSAHS) refers to the partial or complete obstruction of the upper airway. Increased airway resistance affects the breathing process during sleep, resulting in a decline in sleep quality and secondary multiple system damage syndrome. People of any age may appear, and the severity of the disease varies. Children are in a critical period of growth and development, so it has a profound impact on children, which can lead to poor growth, pulmonary heart disease, and hearing effects, such as tinnitus, stuffy ears, hearing loss, etc. Maxillofacial malformation and other serious complications. As the prevalence of OSAHS in children increases, the attention of parents and clinicians is gradually attracted. Most of the studies in China focused on the improvement of surgical methods. This study was inspired by repeated symptoms of some children after operation. Children with snoring with allergic rhinitis initisare treated with surgery combined with desensitization of sublingual Dust mite for sublingual desensitization of children with allergic rhinitis. Objective to study the effects of different surgical therapy combined with surgery and simple operation on the snoring symptoms of OSAHS children with AR. Methods A total of 60 OSAHS children with AR from January 2012 to April 2014 were selected. The results of skin prick test of Dermatophagoides farinae were "or". They were randomly divided into two groups: experimental group (n = 30). The control group (30 cases) were treated by simple operation, bilateral palatal tonsillectomy and augmentation resection were all performed. The children in the experimental group were treated with Dermatophagoides farinae SLITT from the first month after operation. OSA-18 scale and TNSS scale were used to evaluate sleep snoring symptoms (snoring, mouth opening breathing, apnea, repeated arousal, etc.) and nasal symptoms (intermittent nasal congestion, sneezing, etc.) in the first month, the seventh month, the 13th month and the 19th month after operation. Using statistical analysis method, the score changes before and after treatment and the difference between the two groups before and after treatment were compared. Results there was no significant difference in sleep snoring score and rhinitis symptom score between the two groups before operation, and the scores of snoring symptoms and nasal symptoms in the first month after operation were higher than those before operation. The scores of snoring and nasal symptoms in the experimental group were significantly lower than those in the first month after desensitization, and there was no significant difference between the 18 months after desensitization and the 12th month after desensitization: in the control group, the scores of snoring and nasal symptoms in the control group were significantly lower than those in the control group. The snoring symptoms in the 7th, 13th and 19th month after operation were significantly higher than those in the first month after operation, but there was no significant difference in the score of nasal symptoms between the 7th, 13th and 19th months after operation and the first month after operation. Conclusion Surgical therapy combined with SLIT can significantly improve snoring and AR related symptoms in children, increase operative efficacy and reduce postoperative recurrence.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R766.9;R765.21

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