全麻下小儿腺样体及扁桃体摘除术58例围术期护理

目的:探讨全麻下腺样体及扁桃体摘除术治疗儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿围术期的护理方法.方法:对58例OSAHS患儿在全麻下行腺样体及扁桃体摘除术,术前进行充分细致的准备,术中实施针对性的心理护理、严密观察病情,术后给予完善的护理.结果:本组治愈55例(94.8%),好转2例(3.5%),无效1例(1.7%),总有效率98.3%.结论:对OSAHS患儿在全麻下行腺样体及扁桃体摘除术,围术期给予精心护理,有利于患儿顺利度过麻醉和手术期,从而减轻其痛苦,缩短住院时间,促进早日康复.     

儿童阻塞性睡眠呼吸暂停低通气综合征行腺样体、扁桃体摘除术的疗效观察

目的 探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿的扁桃体、腺样体切除术治疗。方法 时58例OSAHS患儿行扁桃体、腺样体切除术，观察惠儿术前、术后情况。结果 58例OSAHS患儿行扁桃体、腺样体切除术治疗，56例治愈，2例显效。结论 对OSAHS患儿行扁桃体、腺样体切除手术是有效、安全的治疗措施。     

全麻下小儿腺样体及扁桃体摘除术58例围术期护理

目的：探讨全麻下腺样体及扁桃体摘除术治疗儿童阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿围术期的护理方法。方法：对58例OSAHS患儿在全麻下行隙样体及扁桃体摘除术，术前进行充分细致的准备，术中实施针对性的心理护理、严密观察病情，术后给予完善的护理，结果：本组治愈55例（94．8％），好转2例（3．5％），无效1例（1．7％），总有效率98．3％．结论：对OSAHS患儿在全麻下行腺样体及扁桃体摘除术，围术期给予精心护理，有利于患儿顺利度过麻醉和手术期，从而减轻其痛苦，缩短住院时间，促进早日康复。     

32例小儿扁桃体腺样体摘除术的护理指导分析

目的 探讨小儿扁桃体腺样体摘除术的护理指导方法与效果.方法 对32例小儿扁桃体腺样体摘除术患儿术前对患儿进行全面评估,完善各种术前准备;术中与术后后重点加强生命体征的观察,加强营养支持.结果 本组患者术中生命体征均平稳、体温维持在36.2～7.5℃,无1例术中发生护理并发症.术后患儿多无疼痛或轻度疼痛发生.结论 手术摘除扁桃体腺样体是治疗小儿扁桃体肿大及腺样体肥大简单有效的方法,也是耳鼻咽喉科较常见手术之一.正确、严密、细致的围手术期护理是保证手术成功的重要环节.     

32例小儿扁桃体腺样体摘除术的护理指导分析

目的 探讨小儿扁桃体腺样体摘除术的护理指导方法与效果.方法 对32例小儿扁桃体腺样体摘除术患儿术前对患儿进行全面评估,完善各种术前准备;术中与术后后重点加强生命体征的观察,加强营养支持.结果 本组患者术中生命体征均平稳、体温维持在36.2～7.5℃,无1例术中发生护理并发症.术后患儿多无疼痛或轻度疼痛发生.结论 手术摘除扁桃体腺样体是治疗小儿扁桃体肿大及腺样体肥大简单有效的方法,也是耳鼻咽喉科较常见手术之一.正确、严密、细致的围手术期护理是保证手术成功的重要环节.     

32例小儿扁桃体腺样体摘除术的护理指导分析

目的 探讨小儿扁桃体腺样体摘除术的护理指导方法与效果.方法 对32例小儿扁桃体腺样体摘除术患儿术前对患儿进行全面评估,完善各种术前准备;术中与术后后重点加强生命体征的观察,加强营养支持.结果 本组患者术中生命体征均平稳、体温维持在36.2～7.5℃,无1例术中发生护理并发症.术后患儿多无疼痛或轻度疼痛发生.结论 手术摘除扁桃体腺样体是治疗小儿扁桃体肿大及腺样体肥大简单有效的方法,也是耳鼻咽喉科较常见手术之一.正确、严密、细致的围手术期护理是保证手术成功的重要环节.     

鼻内镜下扁桃体腺样体联合摘除术治疗小儿阻塞性睡眠呼吸暂停通气综合征62例分析

目的 探讨鼻内镜下扁桃体腺样体联合摘除术治疗儿童OSAHS的临床效果.方法 对62例儿童OSAHS患者鼻内镜下一次性施行扁桃体腺样体摘除术.扁桃体采用挤切法或剥离法,腺样体内镜下吸切器吸除.术后随访3～6个月.结果 62例患者术后睡眠打鼾、憋气、张口呼吸、呼吸暂停等症状全部消失.术后无并发症.结论 鼻内镜下扁桃体腺样体联合摘除术是治疗儿童OSAHS的有效方法.     

儿童阻塞性睡眠呼吸暂停低通气综合征150例分析

目的 探讨儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的病因和手术治疗.方法 回顾性分析150例确诊为OSAHS的患儿的临床症状、体征及特殊检查结果,寻找其发病原因及诊断手段.对腺样体、扁桃体肥大的患儿进行手术治疗,评价其疗效.结果 扁桃体、腺样体肥大是引起儿童OSAHS的主要原因.所有患儿均行腺样体和(或)扁桃体切除术,术后随访0.5～1年,104例痊愈,占69.3%,41例好转,占27.3%,5例无效,占3.3%.有效率为96.7%.其中无效的5例为合并肥胖患儿.结论 儿童OSAHS在病因上有其特殊性,病史与多导睡眠监测(PS6)是主要的诊断依据,腺样体和扁桃体切除手术是有效的治疗方法.     

低温等离子射频消融术治疗儿童OSAHS临床观察

目的探讨低温等离子射频消融术治疗儿童腭扁桃体和腺样体肥大的阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)疗效.方法对35例腺样体和腭扁桃体肥大的OSAHS患儿行鼻内镜下低温等离子射频腺样体、扁桃体消融术并与同期行扁桃体常规剥离法切除加鼻内镜下吸割器腺样体切除术的35例OSAHS患儿进行比较.结果等离子组手术与传统手术相比,手术时间缩短、术中出血量少、术后疼痛减轻.等离子组患儿术后3个月多导睡眠图(polysomnogram,PSG)检查呼吸暂停低通气指数(AHI)、夜间最低血氧饱和度有显著改善,手术前后差异有统计学意义(P<0.05),术后3个月随访上呼吸道阻塞症状改善总有效率为97.1%,PSG复查总有效率为94.3%.无一例并发症出现.结论鼻内镜下低温等离子射频消融腺样体、扁桃体术治疗儿童OSAHS简单、安全、有效,是目前儿童治疗OSAHS值得推荐的一种选择.     

儿童阻塞性睡眠呼吸暂停低通气综合征80例分析

目的探讨扁桃体切除术＋鼻内镜下腺样体切除术治疗儿童阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的临床疗效。方法对80例OSAHS患儿行扁桃体切除术＋鼻内镜下应用电动切割器行腺样体切除术观察其疗效。结果 80例患儿72例治愈,好转6例,总有效率97.5%。结论扁桃体切除术＋鼻内镜下腺样体切除术治疗儿童OSAHAS的疗效显著。     

儿童阻塞性睡眠呼吸暂停低通气综合征的手术治疗

目的:探讨儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)的手术治疗及术后疗效。方法:对29例阻塞性睡眠呼吸暂停低通气综合征的患儿,采用在鼻内镜辅助下低温等离子射频消融术治疗肥大的腺样体及手术切除肥大的扁桃体,观察其转归情况。结果:术后随访3～12个月93.1%患儿打鼾、憋气症状都有不同程度改善;无腺样体残留、无鼻咽粘连及鼻咽闭锁等并发症。结论:手术切除肥大的扁桃体及腺样体是治疗儿童OSAHS的主要手段。鼻内镜辅助下低温等离子射频消融术治疗肥大的腺样体具有直视下操作、病变切除彻底、疗效明显、安全性高、创伤小及并发症少等优点。     

小儿腺样体切除术后OSAHS复发原因探讨

腺样体肥大伴OSAHS是儿童常见疾病,手术治疗已成为主要治疗方法,但手术后OSAHS复发的案例不在少数,现根据各文献报导,分析腺样体肥大术后OSAHS复发的原因主要为:传统腺样体刮除术等手术未完全切除腺样体,合并分泌性中耳炎、鼻-鼻窦炎等临近器官疾病,扁桃体等淋巴组织代偿增生,肥胖等。积极治疗原发疾病,控制炎症发生是避免腺样体切除术后OSAHS复发的有效途径。     

UPPP联合舌根射频消融术治疗OSAHS护理体会

目的:探讨悬雍垂腭咽成形术(UPPP)联合舌根射频消融术治疗重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效及护理方法。方法:34例OSAHS患者接受了UPPP联合舌根射频术,均制定了详细的术前术后护理措施。结果:术后舌根体积明显缩小,术后6个月、1年复查多导睡眠监测(PSG)AH I均明显低于术前(P<0.01),最低SaO2均明显高于术前(P<0.01),术后6个月总有效率为100%,术后1年总有效率为91.18%。结论:同期UPPP联合舌根射频消融术治疗口咽及舌咽平面同时阻塞的重度OSAHS患者,是一种见效快且持久、疗效好的治疗方案。     

Current thinking on tonsillectomy and adenoidectomy

Tonsillectomy and adenoidectomy, though less frequently performed now than in the 1930s, remain among the most common surgical procedures in the United States. The need for and benefits of tonsillectomy and adenoidectomy have been a source of controversy for several decades. Nonetheless, there are situations in which these procedures definitely are beneficial. Tonsillectomy and adenoidectomy are two distinct procedures with separate indications, and they are performed concurrently only when the specific indications for each coexist. Tonsillectomy is indicated by recurrent tonsillitis, peritonsillar abscess, chronic tonsillitis, tonsillar neoplasm, or tonsillar hypertrophy that is obstructive to the upper aerodigestive tract (respiratory distress, dysphagia, or interference with performance of an adenoidectomy). Adenoidectomy is indicated for nasal airway obstruction due to adenoidal enlargement from hypertrophic or inflammatory processes. Although correlation exists among obstructive adenoids, mouth breathing, and dentofacial anomalies, present evidence is not sufficient to justify adenoidectomy solely on the basis of craniofacial or dentofacial abnormalities. Today, elimination of an occult source of infection (once called focal infection) in patients with disorders such as rheumatic fever or serous otitis media is not a valid indication for either operation. Contraindications to tonsillectomy and adenoidectomy include bleeding disorders, familial anesthetic intolerance, velopharyngeal insufficiency, and concurrent disease that may enhance operative risks. Like all surgical procedures, tonsillectomy and adenoidectomy entail morbidity and risk of mortality. The most frequent complication of these operations is hemorrhage. Risk of mortality is approximately 0.006%. Mortality and morbidity can be minimized by appropriate preoperative evaluation, complete control of the airway with endotracheal anesthesia, and meticulous surgical technique.     

Clinical observation of soft palate-pharyngoplasty in the treatment of obstructive sleep apnea hypopnea syndrome in children

BACKGROUND Childhood obstructive sleep apnea hypopnea syndrome(OSAHS)is a common clinical disease that can cause serious complications if not treated in time.The preferred treatment for OSAHS in children is surgery.AIM To observe the effects of soft palate-pharyngoplasty on postoperative outcome,pharyngeal formation,and possible complications.METHODS A total of 150 children with snoring,hernia,and mouth breathing were selected.A polysomnography test was performed to confirm the diagnosis of OSAHS.The children were randomly divided into experimental and control groups.The experimental group underwent adenoidectomy,tonsillectomy,and soft palatepharyngoplasty.The control group underwent adenoidectomy and tonsillectomy.The t-test and chi-square test were used to compare conditions such as postoperative fever,postoperative hemorrhage,and pharyngeal reflux.Postoperative efficacy and complications were interrogated and observed in the form of outpatient follow-up and telephone follow-up at 6 mo and 1 year after surgery.The curative effects were divided into two groups:Cure(snoring,snoring symptoms disappeared)and non-cure.RESULTS The effective rate of the experimental group was significantly higher than that of the control group,but the difference was not statistically significant(P>0.05).The incidence of postoperative bleeding was lower in the experimental group.There was no postoperative pharyngeal reflux in either group.In the experimental group,the incidence of hyperthermia(body temperature exceeded 38.5°C)was lower than that in the control group.The difference in postoperative swallowing pain scores between the experimental and control groups was significant.CONCLUSION Soft palate-pharyngoplasty can more effectively enlarge the anteroposterior diameter and transverse diameter of the isthmus faucium.Compared with surgery alone,it can better treat OSAHS in children,improve the curative effect,reduce the risk of perioperative bleeding,close the surgical cavity,reduce the risk of postoperative infection,reduce the proportion of postoperative fever,and accelerate healing.Although this process takes more time,it is simple,safe,and effective.     

经鼻内镜腺样体切除术对腺样体肥大儿童心理状况的影响

目的探讨腺样体肥大（AH）患儿的心理状况及经鼻内镜腺样体切除手术对其影响。方法应用儿童抑郁障碍自评量表（DSRSC）、儿童焦虑性情绪障碍筛查表（SCARED）对63例AH患儿鼻内镜腺样体切除手术治疗前后的心理状况进行分析，同时与健康对照组进行对比。结果AH患者儿童抑郁障碍自评量表、儿童焦虑性情绪障碍筛查表因子分较对照组明显增高（P〈0．05）。经鼻内镜腺样体切除术后3个月各项目评分趋于好转。结论AH患儿存在显著的心理卫生障碍，经鼻内镜腺样体切除术治疗有助于患儿的身心康复。     

Indications for tonsillectomy and adenoidectomy

Tonsillectomy and adenoidectomy are separate procedures that should be performed for distinct reasons. Studies now indicate that severe, recurrent pharyngitis responds well to tonsillectomy. According to separate recommendations from the American Medical Association and the American Academy of Pediatrics, patients are candidates for tonsillectomy if they have four or more episodes of pharyngitis a year. Recurrent otitis media and chronic otitis media are improved by adenoidectomy, although placement of pressure-equalizing tubes remains the preferred initial treatment for these conditions. Adenotonsillectomy improves severe upper airway obstruction (cor pulmonale and obstructive sleep apnea), as well as milder forms of airway obstruction (loud snoring). The effectiveness of these procedures in proposed indications, such as sinusitis and adenoiditis, is less well substantiated.     

鼾症对儿童生长发育的影响及手术治疗疗效

目的探讨鼾症对儿童生长发育的影响机制及腺样体切除术的治疗疗效。方法测量36例3～10岁鼾症患儿术前、术后6个月的身高、坐高、血清生长激素水平,进行多导睡眠检测;选取与其条件相当且无任何躯体及精神疾病的正常儿童36例作为对照组,同步测量身高、体重、血清生长激素水平。结果鼾症组患儿身高、坐高、血清生长激素水平均低于对照组正常儿童,差异有统计学意义(P﹤0.05);鼾症组患儿行扁桃体和腺样体切除术6个月后,再次测量患儿的身高、坐高、血清生长激素水平,与对照组相比差异无统计学意义(P﹥0.05)。结论睡眠呼吸障碍引起生长激素分泌减少,从而影响儿童的生长发育,应尽早干预。扁桃体、腺样体切除术对睡眠呼吸障碍有显著的治疗作用。     

Tonsillectomy and adenoidectomy.

Tonsillectomy and adenoidectomy is the definitive treatment for chronic tonsillitis and adenoid hypertrophy. It is most important to determine if the patient has chronic tonsillitis--a diagnosis that can only be made between acute attacks when the patient is clinically well. Decisions regarding the need for a tonsillectomy and adenoidectomy should be made only at this time and never during an episode of acute tonsillitis. Frequency of acute attacks should not by itself be the indication for surgery. The family physician who performs tonsillectomy and adenoidectomies has an opportunity to correlate the preoperative and postoperative clinical course of the patient with the findings at the time of surgery. In my experience, patients carefully selected for tonsillectomy and adenoidectomy on the basis of these criteria do benefit from the surgery, and the clinical improvement is sustained in the long-term follow up of these patients.     

悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停低通气综合征患者的护理

目的探讨悬雍垂腭咽成形术(UPPP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的围术期护理方法。方法回顾性分析78例OSAHS患者行全麻下UPPP的围术期护理措施。结果本组患者住院时间8~13 d,平均9.5 d,术后3个月多导睡眠监测结果显示显效58例,有效20例。结论做好OSAHS患者的围术期护理可帮助患者顺利完成手术治疗,并减轻患者术后痛苦、减少并发症的发生;有效的健康宣教可以建立良好的遵医行为,提高OSAHS患者的生活质量。