手术治疗腺样体肥大对儿童睡眠结构影响.docVIP

手术治疗腺样体肥大对儿童睡眠结构影响 　 【关键词】 儿童睡眠 children with adenoidal hypertrophy Abstract: Objective To evaluate the changes of sleep architecture in children with adenoidal hypertrophy after adenoidectomy. Methods From January 2003 to October 2006, polysomnography (PSG) was performed on 120 children with adenoidal hypertrophy before and after adenoidectomy. Various polygraphic parameters describing the macrostructure of sleep and the microstructure of sleep were analyzed . Results The S1 and S2 stages were not significantly changed after adenoidectomy (Pgt;0.05), and the SWS and REM stages increased in ratio (Pgt;0.05). But the arousals index before adenoidectomy was higher than that after adenoidectomy (6.3±0. 4 vs 2.8±0.3，Plt;0.01) and the SaO2 before operations was lower than that after operations （70.3±1.3 vs 93.4±1.4） (Plt;0.01). Conclusions There are no significant differences in the macrostructure of sleep after adenoidectomy. Improvement of the microstructure of sleep in children with adenoidal hypertrophy is the physiopathological basis of clinical relief after adenoidectomy. Key words: Adenoidal hypertrophy; Adenoidectomy; Sleep architecture; Child 儿童腺样体肥大常会因为细菌、病毒等上呼吸道感染而反复发作，出现病理性增生肥大，并导致睡眠时打鼾、厌食、呕吐、消化不良等症状，继而发生营养不良、生长发育障碍，智能障碍以及心理行为异常等。有些学者认为［1］，这些并发症与睡眠时长期的缺氧和频繁觉醒导致的睡眠结构异常有关。手术切除肥大的腺样体可以缓解上呼吸道阻塞，减轻或消除腺样体肥大引起的症状［2］。目前国内外学者对腺样体肥大(AH)儿童的睡眠结构报道较少，我们对120例腺样体肥大(AH)患儿手术前后睡眠结构的变化进行了初步探索，现报告如下。 1 资料与方法 1.1 一般资料 2003年1月至2006年10月，我院收治120例腺样体肥大(AH)患儿，其中男87例，女33例， 4 15岁，平均 (7.8±2.4)岁，均夜间睡眠时有鼾声、张口呼吸、呼吸暂停等症状表现，鼻内镜下观察腺样体占后鼻孔的比例均≥75 %，部分堵塞咽鼓管咽口，扁桃体肥大、颅面畸形及神经肌肉疾病的患儿排除在外。本组患儿均在全麻插管下行鼻内镜下腺样体切除术，并应用32导睡眠呼吸监测仪(PSG)（美国，Polysmith）分别于术前及术后1个月对其进行夜间睡眠监测。 1.2 睡眠结构分析 根据Schoolle等［3］的方法，将睡眠结构分为宏观和微观两种。宏观睡眠结构包括睡眠效率和睡眠分期各阶段的比例，微观睡眠结构包括最低SaO2情况和觉醒指数(AI)。睡眠分期根据Rechtschaffen等［4］制定的标准，即将睡眠分为睡眠Ⅰ期(S1)、睡眠Ⅱ期(S2)、慢波睡眠（SWS）期: Ⅲ期+Ⅳ期、快动眼睡眠(REM)。 1.3 统计学处理 采用SPSS 11.0软件分析，手术前后各组数据行t检验。 2 结 果 2.1 宏观睡眠结构 120例腺样体肥大(AH)患儿腺样体切除手术前后宏观睡眠结构的变化， 见表1。表 1 120例腺样体肥大(AH)患儿腺样体切除手术前后宏观睡眠结构的变化(%) 睡眠效率 S1期所占比例 S2期所