无创通气治疗儿童阻塞性睡眠呼吸暂停低通气综合征的临床观察

目的研究无创通气治疗儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleepapnea hypopnea syndrom e,OSAHS)的有效性和安全性。方法2002年5月至2004年6月经多道睡眠监测(polysomnography,PSG)仪或便携式睡眠呼吸监测仪诊断为OSAHS的21例患儿行无创通气治疗,其中男17例,女4例;年龄40 d~11岁,平均年龄4.5岁。所有患儿经鼻持续正压通气(nasalcontinuous positive airway pressure,nCPAP)治疗后再次行PSG监测。无创通气治疗顺应性的数据通过临床随访、电话随访而获得。统计数据以x-±s表示,nCPAP治疗前后的呼吸参数变化采用配对t检验。结果患儿使用nCPAP的压力在4.8~16.0 cm H2O(1 cm H2O=0.098 kPa)之间。nCPAP治疗前平均的睡眠呼吸暂停低通气指数(apnea hypopnea index,AH I)、最低血氧饱和度及血氧饱和度低于0.90占睡眠时间的百分比分别为(80.8±45.1)次/h、0.557±0.135和(42.9±31.9)%,与治疗后(6.7±12.4)次/h、0.862±0.082和(1.1±2.5)%相比有显著改善(P值均<0.01)。结论无创通气可以安全有效治疗儿童OSAHS,既可长期家庭治疗,也可短期应用。

Noninvasive ventilation for obstructive sleep apnea hypopnea syndrome in children

OBJECTIVE: To study the efficacy and safety of noninvasive ventilation (NV) for treating children with obstructive sleep apnea. METHODS: Twenty-one children confirmed obstructive sleep apnea hypopnea syndrome (OSAHS) with full-night polysomnography (PSG) or ambulatory screening device were enrolled in the study. The NV treatment was carried out successfully for all cases. Nasal continuous positive airway pressure (nCPAP) compliance data were gathered via clinical follow-up examination, telephone interview, or mailed questionnaire. The statistical analysis was performed with SPSS 11.0 statistical software. Pre- and on-nCPAP parameters were compared with paired t-test. Twenty-one OSAHS children (17 boys, 4 girls) were enrolled into the study. The mean age of the children was 4. 5 years; ranging from 40 days to 11 years. RESULTS: nCPAP pressure was increased from 4 cm H2O by (1 cm H2O = 0.098 kPa) 0.2 cm H2O each time to the treating pressure which was between 4.8 and 16 cm H2O. Before nCPAP treatment, apnea hypopnea index (AHI) was (80.8 +/- 45.1)/h, the lowest pulse oxygen saturation (SPO2) 0.557 +/- 0.135 and SPO2 <0.90 time during sleep (42.9 +/- 31.9) %, which were much worse compared to that with nCPAP treatment, the above parameters decreased to (6.7 +/- 12.4)/h, 0.862 +/- 0.082, (1.1 +/- 2.5) % respectively(P <0.01). CONCLUSIONS: Noninvasive ventilation is a safe and effective treatment for OSAHS children. It is possible to use nCPAP as a short-term treatment or as a long-term treatment at home.