手术和药物治疗儿童腺样体肥大的临床疗效观察

发布时间：2018-10-19 16:26

【摘要】：目的:本次采用随机对照法研究手术治疗和药物治疗伴有呼吸相关睡眠障碍症状的腺样体肥大的临床疗效,一方面希望为临床腺样体肥大规范化治疗提供参考依据,另一方面通过前瞻性研究药物治疗已有伴随症状的腺样体肥大的可行性,已期为临床上推广保守治疗腺样体肥大提供临床依据。方法:实验研究对象选自我院门诊自2016年1月初到2016年12月底临床上诊断为伴呼吸相关睡眠障碍症状的中、高度腺样体肥大生病儿童59例(所有研究对象病史均12周)。遵循随机对照的原则分为三个实验组,其中A组即手术组(行气静复合麻醉后鼻内镜下腺样体吸切术)19例,B组即联合用药组(口服孟鲁司特钠+鼻用糠酸莫米松鼻喷剂)20例,C组即单独药物组(单一口服孟鲁司特钠)20例,治疗时间3个月,比较三组研究对象治疗前、后呼吸相关睡眠障碍症状问卷调查总评分(依据改良后Bitar评分[1])、电子鼻咽镜下腺样体体积好转率,采用计数资料卡方检验,计量资料以均数±标准差表示,进行t检验、卡方检验等统计学检验,p0.05为差异有统计学意义。结果:三组治疗前呼吸相关睡眠障碍症状总评分差异无统计学意义(F=0.511,P0.05),接受治疗3个月后,三组呼吸相关睡眠障碍症状总评分差异有统计学意义(F=21.829,P0.05),A组较B、C组治疗后总评分差异均有统计学意义(χ2=10.810,29.476,P0.017),腺样体体积好转率A组优于B、C组。B组与C组治疗后总评分差异有统计学意义(χ2=6.465,P0.017),腺样体体积好转率B组优于C组。结论:手术治疗和药物治疗伴呼吸相关睡眠障碍症状的中、高度腺样体肥大,均可一定程度缓解生病儿童临床症状,消除不良体征。手术治疗疗效最显著,联合药物治疗优于单独药物治疗。针对拒绝早期手术干预治疗的生病儿童,优先考虑联合药物保守治疗3个月,若改善无效或有症状加重情况,仍建议及早接受手术治疗。
[Abstract]:Objective: to study the clinical effect of adenoid hypertrophy with apnea associated sleep disorder by using randomized controlled method, in order to provide reference for the standardized treatment of adenoid hypertrophy. On the other hand, the feasibility of drug therapy for adenoid hypertrophy with symptoms has been studied prospectively, which provides clinical basis for the clinical application of conservative treatment of adenoid hypertrophy. Methods: the subjects of the study were 59 children with high adenoid hypertrophy who were clinically diagnosed as apnea associated sleep disorder from January 2016 to December 2016 (all the subjects' history was 12 weeks). According to the principle of random control, they were divided into three experimental groups. There were 19 cases in group A (adenoidectomy under nasal endoscope after combined anesthesia), 20 cases in group B (oral montelukast sodium for nasal use of amethasone furoate) and 20 cases in group C (single oral drug). 20 patients were treated with montelukast sodium. The duration of treatment was 3 months. The total score of questionnaire (based on improved Bitar score [1]) before and after treatment was compared between the three groups. The improvement rate of adenoid volume under electronic nasopharyngoscope was measured by chi-square test. The measurement data were expressed as mean 卤standard deviation. T test, chi-square test and other statistical tests were performed, p0.05 was statistically significant. Results: there was no significant difference in the total score of the three groups before treatment (FV 0.511 P 0.05), but after 3 months of treatment, there was no significant difference in the total score of the three groups. There were significant differences in the total scores of respiratory related sleep disorders among the three groups (FF21.829P 0.05) compared with those in group C (P 0.017). The improvement rate of adenoid volume in group A was better than that in group B (P 0.017), and the difference in total score between group B and group C was significant (P < 0.05). The difference was statistically significant (蠂 2, 6.465, P 0.017). The improvement rate of adenoid volume in group B was better than that in group C. Conclusion: the moderate and high adenoid hypertrophy associated with apnea associated sleep disorder in surgical treatment and drug therapy can alleviate the clinical symptoms and eliminate the adverse signs in children with diseases. Surgical treatment is the most effective, combined drug therapy is better than the single drug treatment. For the sick children who refuse early surgical intervention, priority should be given to the combination of medication and conservative treatment for 3 months. If the treatment is ineffective or symptomatic exacerbation, it is still recommended to receive surgical treatment as early as possible.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R766.9

【参考文献】