低溫等離子消融術治療兒童阻塞性睡眠呼吸暫停低通氣綜合征的臨床療效_《中國循證醫學雜志》

作者：

王潔 ,  劉大波 , 黃振云 , 鐘建文 , 譚宗瑜 , 仇書要

廣州市婦女兒童醫療中心（廣州?510120）;

關鍵詞：

低溫等離子消融術兒童阻塞性睡眠呼吸暫停低通氣綜合征

DOI：

10.7507/1672-2531.20090125

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目的　探討低溫等離子消融術治療兒童阻塞性睡眠呼吸暫停低通氣綜合征（obstructive sleep apnea hypopnea syndrome，OSAHS）的療效及其安全性。
方法　2007年6月至2008年5月，對經多導睡眠監測證實為OSAHS的82例患兒（3～14歲，平均年齡6.2歲），在全麻下使用美國Arthrocare公司的ENT CoblatorII 等離子系統治療儀，連接EVac 70 T amp;A 刀頭，切除扁桃體和（或）消融腺樣體，并于術前及術后6個月行多導睡眠儀監測，以確定治療效果。
結果　所有患兒術中、術后無明顯并發癥發生。術后隨訪6個月，患兒均取得滿意療效。與治療前比較，在提高最低血氧飽和度和降低呼吸暫停低通氣指數方面，差異有統計學意義（P lt;0.001）。隨訪6個月后，有45例患兒按療效評定標準評定為治愈，21例顯效，10例有效，6例無效，治療總有效率達92.6%。
結論　低溫等離子消融術具有較好的臨床療效，且手術時間縮短，術中術后出血少，術后疼痛明顯減輕，并發癥少，無不良反應，操作簡單，可有效擴大鼻咽、口咽部通氣截面積，解除上氣道阻塞因素，尤其適合兒童OSAHS的手術治療。

引用本文： 王潔,劉大波,黃振云,鐘建文,譚宗瑜,仇書要. 低溫等離子消融術治療兒童阻塞性睡眠呼吸暫停低通氣綜合征的臨床療效. 中國循證醫學雜志, 2009, 09(6): 709-712. doi: 10.7507/1672-2531.20090125 復制

1.	Am in RS, Kimball TR, Bean JA, et al. Left ventricular hypertrophy and abnormal ventricular geometry in children and adolescents with obstructive sleep apnea. Am J Respir Cirt Care Med, 2002, 165: 1395-1399.
2.	Goldste in NA, Post C, Rosenfeld RM, et al. Impact of tonsillectomy and adenoidectomy on child behavior, Arch. Otolaryngol Head Neck Surg, 2002, 126: 494-498.
3.	蔡曉嵐, 劉洪英, 范獻良, 等. 兒童阻塞性睡眠呼吸暫停低通氣綜合征的診斷. 中華耳鼻咽喉科雜志, 2003, 38(3): 161 -165.
4.	中華耳鼻咽喉頭頸外科雜志編委會, 中華醫學會耳鼻咽喉科學分會, 兒童阻塞性睡眠呼吸暫停低通氣綜合征診療指南草案 (烏魯木齊). 中華耳鼻咽喉頭頸外科雜志, 2007, 42: 83-84.
5.	Richards W, Ferdman RM. Prolonged morbidity due to delays in the diagnosis and treatment of obstructive sleep apnea in children. Chin Pediatr(Phia), 2000, 39(2): 103-108.
6.	Lip ton AJ, Gozal D. Treatment of obstructive sleep apnea in children: do we really know how? Sleep Med Rev, 2003, 7: 61-80.
7.	Friedman M, LoSavio P, Ibrahim H, et al. Radiofrequency tonsil reduction: safety, morbidity, and efficacy. Laryngoscope, 2003, 113(5): 882-887.
8.	Temple RH, Timms MS. Paediatric coblation tonsillectomy. Int. J. Pediatr. Otorhinolaryngol, 2001, 61: 195-198.
9.	Stoker KE, Don DM, Kang DR, et al. Pediatric total tonsillectomy using coblation compared to conventional electrosurgery: a prospective, controlled, singleblind study. Otolaryngol. Head Neck Surg, 2004, 130: 666-675.
10.	Chang KW. Randomized controlled trial of coblation versus electrocautery tonsillectomy. Otolaryngol. Head Neck Surg, 2005, 132: 273-280.
11.	Hall DJ, Littlefield PD. Radiofrequency ablation versus electrocautery in tonsillectomy. Otolaryngol. Head Neck Surg, 2004, 130: 300-305.
12.	Divi V, Benninger M. Postoperative tonsillectomy bleed: coblation versus non-coblation. Laryngoscope, 2005, 115: 31-33.
13.	Shah UK. What surgeons want in a tonsillectomy instrument:survery of American Society of Pediatric Otolaryngology members. Annu Meet Am Soc Pediatr Otolaryngol, Chicago, May 2006.

1. Am in RS, Kimball TR, Bean JA, et al. Left ventricular hypertrophy and abnormal ventricular geometry in children and adolescents with obstructive sleep apnea. Am J Respir Cirt Care Med, 2002, 165: 1395-1399.
2. Goldste in NA, Post C, Rosenfeld RM, et al. Impact of tonsillectomy and adenoidectomy on child behavior, Arch. Otolaryngol Head Neck Surg, 2002, 126: 494-498.
3. 蔡曉嵐, 劉洪英, 范獻良, 等. 兒童阻塞性睡眠呼吸暫停低通氣綜合征的診斷. 中華耳鼻咽喉科雜志, 2003, 38(3): 161 -165.
4. 中華耳鼻咽喉頭頸外科雜志編委會, 中華醫學會耳鼻咽喉科學分會, 兒童阻塞性睡眠呼吸暫停低通氣綜合征診療指南草案 (烏魯木齊). 中華耳鼻咽喉頭頸外科雜志, 2007, 42: 83-84.
5. Richards W, Ferdman RM. Prolonged morbidity due to delays in the diagnosis and treatment of obstructive sleep apnea in children. Chin Pediatr(Phia), 2000, 39(2): 103-108.
6. Lip ton AJ, Gozal D. Treatment of obstructive sleep apnea in children: do we really know how? Sleep Med Rev, 2003, 7: 61-80.
7. Friedman M, LoSavio P, Ibrahim H, et al. Radiofrequency tonsil reduction: safety, morbidity, and efficacy. Laryngoscope, 2003, 113(5): 882-887.
8. Temple RH, Timms MS. Paediatric coblation tonsillectomy. Int. J. Pediatr. Otorhinolaryngol, 2001, 61: 195-198.
9. Stoker KE, Don DM, Kang DR, et al. Pediatric total tonsillectomy using coblation compared to conventional electrosurgery: a prospective, controlled, singleblind study. Otolaryngol. Head Neck Surg, 2004, 130: 666-675.
10. Chang KW. Randomized controlled trial of coblation versus electrocautery tonsillectomy. Otolaryngol. Head Neck Surg, 2005, 132: 273-280.
11. Hall DJ, Littlefield PD. Radiofrequency ablation versus electrocautery in tonsillectomy. Otolaryngol. Head Neck Surg, 2004, 130: 300-305.
12. Divi V, Benninger M. Postoperative tonsillectomy bleed: coblation versus non-coblation. Laryngoscope, 2005, 115: 31-33.
13. Shah UK. What surgeons want in a tonsillectomy instrument:survery of American Society of Pediatric Otolaryngology members. Annu Meet Am Soc Pediatr Otolaryngol, Chicago, May 2006.

《中國循證醫學雜志》

低溫等離子消融術治療兒童阻塞性睡眠呼吸暫停低通氣綜合征的臨床療效

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《中國循證醫學雜志》

低溫等離子消融術治療兒童阻塞性睡眠呼吸暫停低通氣綜合征的臨床療效

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