Approach to the snoring child

Sleep is an important component in a child’s growth and development. Snoring is common in children and often perceived as benign, but habitual snoring may be an indication of obstructive sleep apnoea (OSA). OSA can have health, developmental and cognitive consequences. The three common risk factors for paediatric OSA are tonsillar and/or adenoidal hypertrophy, obesity and allergic rhinitis. Primary care providers are well-placed to identify children at risk by screening for habitual snoring and associated OSA risk factors during routine consultations. Physician awareness of OSA symptoms/signs facilitates diagnosis, management and referral decisions. A trial of medical treatment may be considered for habitual snoring with mild symptoms/signs before referral. Overnight polysomnography is the gold standard investigation utilised by paediatric sleep specialists to diagnose OSA. Adenotonsillectomy is the first-line management for OSA with adenotonsillar hypertrophy, but residual/recurrent OSA may occur, so follow-up by primary care providers is important after surgery.     

Perfadex液保存供胰的实验研究

目的：观察Ｐｅｒｆａｄｅｘ液保存胰腺的效果。方法：４℃Ｐｅｒｆａｄｅｘ液保存猪胰腺（ｎ＝５）１０ｈ后作同种异体胰腺十二指肠移植。检测胰腺组织结构、能量代谢改变,组织总水含量并观察移植胰腺内、外分泌功能。结果：猪胰腺保存１０ｈ后组织结构完整,总水含量无显著变化,ＡＴＰ含量下降３９％。移植胰腺全部成活,能量代谢恢复,内、外分泌功能逐渐恢复,仅有水肿型早期移植胰腺炎表现。结论：Ｐｅｒｆａｄｅｘ液可保存供胰１０ｈ。     

鼾症儿童多导睡眠图监测的临床意义

目的探讨诱发儿童阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的主要病因和多导睡眠图监测（PSG）参数对儿童OSAHS诊断及鉴别诊断的价值。方法对125例鼾症儿童行PSG和头颅X线侧位片检查,分析呼吸暂停低通气指数（AHI）与扁桃体及腺样体肥大、鼾声指数、最低血氧饱和度的相关性。结果125例鼾症儿童中符合儿童OSAHS诊断标准70例：扁桃体和／或腺样体肥大81例,符合儿童OSAHS诊断标准55例。随着AHI的增大,A／N、T／P及鼾声指数逐渐增大,呈现显著的正相关（r=0635、0528、0815,均P〈0．01）;而最低血氧饱和度逐渐下降,呈现显著的负相关（r=-0787,P〈0．01）。此外,随着AHI的增大,患儿出现呼吸暂停、低通气的总合平均持续时间（均在10s以上）也逐渐延长。结论扁桃体及腺样体肥大是诱发儿童OSAHS的主要病因,行PSG并对其参数进行分析,对于诊断和鉴别诊断儿童OSAHS疾病有着重要的临床意义。     

鼾症手术治疗的远期疗效分析

目的 :探讨鼾症腭咽成形术 (UPPP)的远期疗效。方法 :随访睡眠呼吸暂停综合征 46例行UPPP后的疗效。 46例中男 3 9例 ,女 7例 ,3 2～ 66岁 ,平均 46岁 ,均有睡眠时打鼾、夜间憋气、惊醒、胸闷、白天嗜睡、咽干燥等症状 1～ 40年 ,平均 7.4年。 46例中有高血压史 1 3例。 3 3例局部麻醉 ,1 3例气管插管全身麻醉。 6例同期行鼻中隔矫正术 ,7例同时行下鼻甲骨黏膜下切除术。术后随访 1 2～ 96月 ,平均 3 2月。结果 :46例中 45例 (98% )均在手术后 1～ 3d鼾声消失或减轻 ,憋气、惊醒症状消失。 1例无改善。手术中无并发症。远期随访 40例 (87% ) ,其中呼吸暂停消失 2 3例 (5 7% ) ,好转 1 1例 (2 8% ) ,无好转 6例 (1 5 % )。鼾声消失 1 7例 (4 3 % ) ,好转 1 2例 (3 0 % ) ,无好转 1 1例 (2 7% )。白天嗜睡消失 1 2例 (3 0 % ) ,好转 1 9例 (4 8% ) ,无好转 9例 (2 2 % )。口咽干消失 1 0例(2 5 % ) ,好转 1 8例 (4 5 % ) ,无好转 1 2例 (3 0 % )。症状复发者都在术后 3个月后。随访 5年以上的 8例憋气消失 4例 (5 0 % ) ,好转 4例 (5 0 % ) ,嗜睡消失 5例 (62 % ) ,好转 3例 (3 8% ) ;鼾声消失 5例 (62 % ) ,好转 3例 (3 8% ) ;口咽干消失 3例 (3 8% ) ,好转 4例 (5 0 % ) ,无效 1例 (1 2 % )。 1 3例术前     

Uvulopalatopharyngoplasty as a treatment for snoring

Uvulopalatopharyngoplaty was performed in 18 consecutive patients (15 men and three women; mean +/- standard deviation [SD] age, 46.3 +/- 7.5 years) who presented for the treatment of heavy habitual snoring. No attempt was made to select patients who were ideal anatomically for palatal modification. The loudness of snoring was measured during sleep by integrating the output of a calibrated microphone. An assessment before operation showed that nine patients had obstructive sleep apnoea; four patients had an apnoea index of greater than or equal to 25 apnoeas per hour. The patients were overweight and consumed, on average, 38 g of alcohol per day, but these variables did not change after the operation. The postoperative assessment was performed 138 +/- 44 days after uvulopalatopharyngoplasty. Fourteen patients showed a reduction in the loudness of their snoring, although snoring was abolished in one patient only (average snoring loudness in arbitrary units/min of sleep, 2.8 +/- 2.1 before operation compared with 1.4 +/- 1.5 units/min of sleep after the operation; P less than 0.05. The loudest snore in arbitrary units measured 7.1 +/- 3.3 units compared with 4.8 +/- 3.3 units, respectively; P less than 0.05). The percentage of the sleep time that was spent at an arterial oxygen saturation of less than 90% was reduced after uvulopalatopharyngoplasty (28% +/- 32% of total sleep time compared with 17% +/- 24% of total sleep time, respectively; P less than 0.05). There was no change in the apnoea index. The diastolic blood pressure was lower at the postoperative assessment (94 +/- 11 mmHg compared with 87 +/- 8 mmHg; P less than 0.05); six of 10 subjects whose diastolic blood pressures were greater than or equal to 95 mmHg before the operation had a diastolic blood pressure of less than 95 mmHg after uvulopalatopharyngoplasty (P less than 0.02). Computed tomographic scans showed an increase in the upper airway cross-sectional area at 3 cm and 4 cm above the hyoid bone after uvulopalatopharyngoplasty (P less than 0.05). We conclude that uvulopalatopharyngoplasty is an effective treatment for habitual, heavy snoring in many patients, but it is not the treatment of choice for patients with clinically-significant obstructive sleep apnoea.     

青岛市居民睡眠打鼾的流行病学调查

目的了解青岛市居民睡眠打鼾的患病率和高危因素等情况。方法对2005年6月至2006年12月期间,青岛市459个家庭的1 756人进行了问卷调查,将其中的睡眠打鼾者资料进行了统计处理并对其影响因素进行分析。结果1 756人中共有睡眠打鼾者59例(3.30%),男37例,女22例,男性多于女性(P<0.01),超重和肥胖者与正常体重者无明显差异(P>0.05),有吸烟习惯者高于无吸烟习惯者,有饮酒习惯者与普通人群无统计学差异。结论青岛市约有3.30%的居民睡眠打鼾,患病率随年龄的增大而逐渐升高,男性较女性更容易患病,有吸烟不良生活习惯者高于不吸烟者。     

悬雍垂软腭咽成形术治疗单纯性鼾症

[目的 ]探讨采用不同悬雍垂软腭咽成形术术式治疗单纯性鼾症的并发症和远期疗效 .[方法 ]给 13 5例临床诊断为单纯性鼾症的病人随机行Ⅰ ,Ⅱ ,Ⅲ型悬雍垂软腭咽成形术 ,观察术后疗效 ,并进行回顾性分析 .[结果 ]Ⅰ型悬雍垂软腭咽成形术的有效率为 53 6% ,Ⅱ型为 67 2 % ,Ⅲ型为 72 5% .[结论 ]术式Ⅲ型在切除部分软腭的同时进行悬雍垂成形 ,术后发生鼻咽返流症状的机率明显降低 ,远期疗效较好     

大学生打鼾的危险因素分析

目的通过调查某医科大学在校大学生中打鼾的人群分布特征,对可能引起打鼾的危险因素进行回顾性分析,为预防、控制打鼾提供依据。方法采用整群抽样的方法抽取大学三年级的485名同学进行问卷调查和体格检查,并应用Logistic回归分析进行危险性的评价。结果有效问卷485份,打鼾者占35.7%;单因素分析显示,男性打鼾高于女性,肥胖、鼻咽部疾病、饮酒均为打鼾的相关因素。多因素Logistic回归分析进一步证实,性别、超重、鼻咽部疾病三个因素仍有统计学意义(P<0.05)。结论大学生打鼾患病率较高,肥胖、饮酒、卫生习惯以及鼻咽部疾病等因素与打鼾显著相关。     

某校大学生打鼾状况的流行病学调查

目的:调查某医科大学在校学生中打鼾分布情况及相关危险因素.方法:采用整群抽样的方法抽取2001级11个班级中的328名同学进行问卷调查和体格检查,并对部分相关因素进行分析.结果:收到问卷328份(应答率100%),有效问卷328份(有效率100%).其中打鼾者占36.6%,经常打鼾者占8.2%,男性高于女性(P＜0.05),打鼾的危险因素有肥胖(P＜0.05)、悬雍垂过度(P＜0.05)、颈围(P＜0.05),而仰卧会加重打鼾程度(P＜0.05);父母打鼾情况、吸烟、饮食、运动、心理状况分布未见有统计学差异.结论:大学生打鼾流行率为36.6%,打鼾影响大学生健康的重要问题之一,应当引起重视.     

鼾症手术准备期的护理

1　临床资料2 0 0 1年 1月～ 8月我科选择采用多导睡眠图诊断鼾症共 7例 ,均为男性 ,年龄在 18～ 5 4岁 ,其中重度鼾症 5例 ,轻度鼾症 2例 ,睡眠中二氧化碳分压最低为 5 6%～80 % ,睡眠中呼吸暂停时间为 16～ 3 0ｓ ,7例病人均进行了悬雍垂腭咽成行手术治疗。术后病人呼吸暂停均消失 ,鼾声也明显减小 ,血氧饱合正常 ,有效治疗率为 85 %。2　护理体会2 1　健康宣教随着“以病人为中心”的新型护理模式的实施 ,对病人实施健康教育已是整体护理的重要部分。术前通过有计划、有目的的实施健康教育 ,帮助病人做好术前的身心准备 ,营造温馨的氛围…     

低温等离子射频治疗儿童鼾症的临床观察

目的观察低温等离子射频手术治疗儿童鼾症的疗效。方法55例打鼾患儿行低温等离子射频腺样体和（或）扁桃体切除术,并与同期行鼻内窥镜下腺样体刮除术和（或）扁桃体剥离术的患儿进行比较。结果在行腺样体手术时,射频手术与传统手术相比,手术时间缩短[（23.3±7.0）minvs.29.0±12.5）min]（P=0.00）、术中出血量少[（6.6±4.3）mlvs.37.0±8.4）ml]（P=0.00）、术后疼痛时间缩短[（2.0±1.3）dvs.4.0±0.7）d]（P=0.01）;在行腺样体＋扁桃体手术时,射频手术与传统手术相比,在手术时间[（33.7±8.7）minvs.47.1±8.2）min]、术中出血[（13.8±7.8）mlvs.63.7±19.9）ml]、术后疼痛[（2.7±1.5d）vs.5.9±1.6）d]方面均具优势,术后白膜脱落时间射频手术组长于传统手术组[（9.7±1.3）dvs.7.3±0.9）d]。结论低温等离子射频手术治疗儿童鼾症与传统手术方式相比,具有手术时间短、术中出血少、术后反应轻等优点。     

对睡眠打鼾患者的评价

目的　探讨以打鼾为主诉患者的病情程度 ,并对其临床和实验室资料进行评价。方法　应用AutoSetPortableⅡ正压诊断治疗系统对 83例以打鼾为主诉患者进行诊断并进行夜间连续睡眠呼吸监测 7小时 ,监测指标包括 :血氧饱和度 (SaO2 ) ,最长睡眠呼吸暂停时间 (LAT) ,睡眠呼吸紊乱指数 (AHI)、气道平台指数 ,鼾声指数及鼻通气量等 ,并对各指标进行分析。结果　以打鼾为主诉求治者中 ,男∶女为 7 3∶1。以中年男性及绝经期女性居多。AHI分级中重度占 85 6 %。AHI与颈围、LAT呈正相关。AHI与平台指数≤ 0 15的百分比、鼻通气 <5L/min的百分比及鼾声指数的中位数呈正相关 ,与最低血氧呈负相关。结论　睡眠打鼾患者中 ,诊断符合中重度阻塞性睡眠呼吸暂停低通气(OSAHS)者所占比例较高 ,需要普及宣传以提高患者的认识 ,避免并发症的发生 ,以提高生活质量。     

阻塞性睡眠呼吸暂停低通气综合征和单纯鼾症患者鼾声声压级参数分析

目的：研究阻塞性睡眠呼吸暂停低通气综合征（ OSAHS）和单纯鼾症（ SS）患者鼾声的声压级特点,探讨其临床应用价值。方法对45例OSHAS患者和20例SS患者进行同步多导睡眠监测和鼾声声压级监测（ sound pressure level,SPL）,提取其整夜7 h鼾声的等效连续A声级（LAeq）,峰值（Lpeak）,累积百分数声级（L10、L50和L90）等声压级参数,与睡眠呼吸暂停低通气指数（ AHI ）、体质量指数（ BMI ）及年龄进行相关性分析。结果 SS和OSAHS患者鼾声的LAeq和L10差异有统计学意义。 OSAHS患者的AHI值与LAeq、Lpeak、L10呈正相关,相关系数分别为0．676、0．457、0．653。 BMI与LAeq和L10呈正相关,相关系数分别为0．341和0．379,年龄与LAeq呈负相关,相关系数为-0．279。结论①鼾声的声级参数的大小受患者的AHI大小、BMI及年龄因素影响,而AHI的影响最大,其中又以整夜鼾声的LAeq和L10与AHI关系最为密切;②LAeq和L10能在一定程度上反映睡眠呼吸障碍的严重程度,是鼾声的重要声学特征,对于粗略鉴别SS和OSAHS及评估OSAHS的严重程度具有一定的临床价值。     

Uvulopalatopharyngoplasty for snoring: the Belfast experience.

We have studied thirteen patients to assess the efficacy of uvulopalatopharyngoplasty on snoring and on oxygen desaturation during sleep. Pre- and post-operative overnight pulse oximetry studies were performed and the patients were divided into snorers and those with obstructive sleep apnoea on the basis of the preoperative test. Uvulopalatopharyngoplasty did not result in a significant change in the number of oxygen saturation dips in either snorers or those with the obstructive sleep apnoea syndrome. Subjectively, 85% (11/13) of patients reported good or excellent improvement in snoring following surgery.     

盐酸戊乙奎醚在鼾症患者腭咽成形术麻醉前用药的临床观察

目的:比较盐酸戊乙奎醚和阿托品用于鼾症患者的腭咽成形术术前用药的临床效果。方法:选择60例拟在全麻下行腭咽成形术的患者,ASA Ⅰ-Ⅱ级。随机分成术前肌注阿托品组(A组)和术前肌注盐酸戊乙奎醚组(P组),测定注射后15、30 min唾液分泌量,用视觉模拟评分(VAS)方法测定口干程度,记录不良反应。结果:两组患者一般情况无显著性差异(P>0.05)。肌注后30 min与入室时相比较,两组的口干度评分均有所增加,但组间差异无显著意义,但复苏拔管时,气管内吸引次数组间差异有显著意义(P<0.05)。A组HR显著增快(P<0.05和P<0.01),P组有减慢趋势,在30 min时最明显(P<0.01),但仍在基础值水平。P组与A组相比有显著差异(P<0.05)。结论:在腭咽成形术中盐酸戊乙奎醚能有效抑制腺体分泌,减少口腔分泌物,维持呼吸道干燥,而不增快HR,可取代阿托品成为理想的术前用药,但相对阿托品其价/效比比较高。     

成都地区2—12岁儿童打鼾流行病学调查

目的 了解成都市2～12岁儿童打鼾的流行病学状况及相关因素分析.方法 2004年9～10月间在成都市5个城区中抽取2个区的2个小学和2个幼儿园1600名2～12岁儿童,由专人对家长进行问卷调查.结果 实际回收有效问卷1526份.睡眠障碍患病率为33.4%,其中打鼾为5.6%.打鼾在不同性别、不同年龄阶段差异无统计学意义,肥胖也不是儿童打鼾的危险因素,但遗传因素则与儿童打鼾明显相关,有打鼾阳性家族史的儿童,其发生打鼾的相对危险性为无阳性家族史儿童的2.45倍.结论 成都地区儿童打鼾患病率为5.6%,与国内其他地区基本相同,应当引起重视.     

咽部侧位X线摄影对鼾症的诊断价值

In this paper, X-ray findings of the lateral pharynx before uvulopalatopharyngoplasty in 14 cases of snoring disease were studied. The results are as follows. There is less than 5 mm in anterior-posterior airway of pharyngeal cavity (13 cases), and 8 mm (1 case), in diameter. Minimum 2 mm, average 4.4 mm. There is less than 25 mm length of uvula (7 cases), 28-35 mm (7 cases). Minimum 22 mm, average length is 27.9 mm. Shape of uvula is thick and long (12 cases), thick and short 1 case, thin and long 1 case. The etiology, abnormal X-ray finding and X-ray examination of the lateral pharynx, etc. in snoring disease have been discussed.