多导睡眠监测在OSAHS患儿中的临床应用

目的探讨多导睡眠监测在OSAHS患儿中应用效果。方法 OSAHS患儿73例为观察组,其中41例轻度为A组,22例中度为B组,10例重度为C组。非OSAHS患儿75例为对照组。行多导睡眠监测。结果观察组平均Sa O2、LSa O2、S2期、SWS期、REM期明显小于对照组,观察组Sa O2≤92%时间、LAT、LHT、NREM期、S1期、RDT、RAT明显大于对照组。依A组、B组、C组顺序,NREM期、S1期、RDT、RAT、LAT、LHT均显著增加,S2期、SWS期、REM期均显著降低。差异显著(P0.05)。结论多导睡眠监测是OSAHS患儿有效评价方法。     

Lung function in children and adolescents with idiopathic interstitial pulmonary fibrosis

Lung function of 65 patients who had idiopathic interstitial pulmonary fibrosis (IIPF) that had been treated with prednisone was evaluated by tests of ventilatory function, lung mechanics, and gas exchange at rest and during exercise. Ages on initial investigation ranged from 5 to 20 years. In 35 of 65 patients the studies were repeated an average of four times over a period of 1 to 9 years. Results of the first testing were as follows: vital capacity (VC)-significantly reduced in all patients; inspiratory capacity (IC)-significantly reduced in all patients; total lung capacity (TLC)-reduced in 91%; functional residual capacity (FRC)-reduced in 31%; residual volume (RV)-reduced in 6%; elastic recoil of the lungs (Pstl)-significantly increased in 97% at 100% TLC, significantly increased in 52% at 90% TLC, reduced in 68% at 60% TLC; 7) static compliance (Cst)-reduced in 83%; 8) dynamic compliance (Cdyn)-reduced in 88%; 9) specific airway conductance at FRC level (Gaw/TGVex)-significantly increased in 50%; 10) maximum expiratory flow rates at 60% TLC (Vmax 60% TLC, in TLC/s)-significantly reduced in 33%; 11) upstream airway conductance (Gus 60% TLC, in TLC/s/cm H2O)-reduced in 32%; 12) diffusing capacity of the lungs for carbon monoxide (DLco) related to body-surface area-abnormal in 58% (when corrected for lung size, i.e., DLco/TLC, abnormal in only 8%); 13) PaO2 at rest and after 6 minutes submaximal exercise-reduced in 25% and 63%, respectively. Changes in lung function that occurred with growth were assessed in terms of percentages of predicted values. Results showed that the VC and IC remained significantly reduced. An actual reduction of TLC, FRC, RV, breathing frequency, DLCO, and Pstl at 100% and 90% TLC was observed. Increases were seen in Pstl at 60% TLC, Gaw/TGVex, Vmax, and Cst. Indices of lung elasticity suggested that regions of fibrosis and emphysema had become present. Smaller patients were also noted to have stiffer lungs.     

Nasal corticosteroids for children with snoring

Nasal corticosteroids improve polysomnography indices but not symptoms in children with mild to moderate sleep-disordered breathing. We hypothesized that administration of nasal corticosteroids for 4 weeks to snoring children with only mild elevation in their apnea-hypopnea index would improve both polysomnography findings and symptoms of sleep-disordered breathing. Budesonide 50 mcg per nostril twice daily was administered for 4 weeks to children (2-14 years old) with habitual snoring and an apnea-hypopnea index of 1-10 episodes/hr. Subjects were evaluated before treatment and at 2 weeks and 9 months after its completion. Primary outcome variables were changes in apnea-hypopnea index and symptom score. Twenty-seven children were studied. At 2 weeks, the mean apnea-hypopnea index decreased from 5.2 (+/-2.2) episodes/hr to 3.2 (+/-1.5) episodes/hr, and median oxygen desaturation of hemoglobin index fell from 3.1 (0.4-8.2) to 1.9 (0.2-5.4) (P < 0.0001). Mean symptom score was 1.33 (+/-2.11) at baseline, and decreased to -0.008 (+/-2.24) at 2 weeks after treatment and to -1.08 (+/-1.75) at 9 months after treatment (P < 0.05). Four weeks of nasal budesonide improved both polysomnography findings and symptoms in children with mild sleep-disordered breathing. The clinical effect is maintained for several months after treatment.     

Sleep-disordered breathing in 3,680 Greek children

The goal of the present investigation was to describe the prevalence of and clinical factors associated with sleep-disordered breathing in children and adolescents. Children and adolescents (3,680 in all, 1-18 years old) attending schools in central Greece were surveyed by questionnaires distributed to parents. We found a similar prevalence of habitual snoring (present every night) among three different age groups (5.3%, 4%, and 3.8% in 1-6-, 7-12-, and 13-18-year-old subjects, P = NS). Several children with an adenoidectomy and/or tonsillectomy were snoring every night (6.1%), whereas sleepiness at school was more common in habitual snorers than in nonhabitual snorers (4.6 vs. 2%, P = 0.03). Seventy randomly selected subjects among 307 snorers without adenoidectomy and/or tonsillectomy underwent polysomnography. The estimated frequency of obstructive sleep apnea-hypopnea among children without adenoidectomy and/or tonsillectomy was 4.3%. Factors associated with snoring were: male gender (odds ratio 1.5 (confidence interval, 1.2-1.9)); chronic rhinitis (2.1 (1.6-2.7)); snoring in father (1.5 (1.2-1.9)), mother (1.5 (1.1-2.0)), or siblings (1.7 (1.2-2.4)); adenoidectomy in mother (1.5 (1.0-2.2)); and passive smoking (1.4 (1.1-1.8)). In conclusion, snoring every night was equally prevalent in younger and older ages, more frequent in males, and present even in some children with a history of adenoidectomy and/or tonsillectomy. Chronic rhinitis, family history of snoring, and exposure to cigarette smoke were associated with an increased frequency of habitual snoring.     

Effects of weight loss on pulmonary function in obese men with obstructive sleep apnoea syndrome

Abstract. The effects of long-term behaviour modification of obesity on pulmonary function was studied in eight men with obstructive sleep apnoea syndrome (initial mean body mass index [BMI] 41.8 kg m^?2) before and after a mean weight loss of 20 ± 7 (SD) kg. Mean arterial Pco₂ fell from 6.3 ± 1.2 to 5.5 ± 0.6 kPa (P < 0.05) and concomitant significant improvements were found in vital capacity, total lung capacity, functional residual capacity and forced expired volume (FEV 1.0). The study suggests that weight loss per se, rather than the method of choice to achieve weight loss, results in clinically significant improvement of pulmonary function in obese men.     

Haemorrhagic complications with adenotonsillectomy in children and young adults with bleeding disorders

Haemorrhagic complications remain a challenge with surgical procedures in patients with bleeding disorders. In children and young adults, the most commonly performed surgeries are tonsillectomies and/or adenoidectomies. Adequate haemostasis in these patients with bleeding disorders is centred on comprehensive perioperative haemostatic support and dexterous surgical technique. The aim of this study was to assess postoperative bleeding complications with tonsillectomy and/or adenoidectomy in children and young adults with known bleeding disorders. Retrospective review of all patients aged <25 years with known bleeding disorders who underwent tonsillectomy and/or adenoidectomy at Mayo Clinic, Rochester MN between July 1992 and July 2012. In contrast to reported literature, we observed a higher rate of bleeding complications (10/19, 53%) despite aggressive haemostatic support and appropriate surgical techniques. Delayed bleeding (>24 h postoperatively) was more common than early bleeding; and recurrent bleeding was associated with older age. Children and young adults with haemorrhagic diatheses undergoing adenotonsillectomy are at a higher risk of delayed bleeding and require close monitoring with haemostatic support for a prolonged duration in the postoperative period. A uniform approach is needed to manage these patients perioperatively by establishing standard practice guidelines and ultimately reduce postsurgical bleeding complications.     

Preoperative polysomnograms and infant pulmonary function tests do not predict prolonged postoperative mechanical ventilation in children following scoliosis repair

Our objective was the identification of children with scoliosis at higher risk of prolonged postoperative mechanical ventilation (MV) permits improved pre- and perioperative respiratory care to reduce postoperative complications. Pulmonary function testing (PFT) predicts prolonged postoperative MV in children who can reliably perform PFT, but some children cannot perform PFT. The objective of this study was to determine if polysomnography (PSG) or infant pulmonary function testing (IPFT) could predict prolonged postoperative MV (defined as MV >3 days) in children undergoing scoliosis surgery who could not reliably perform PFT. We studied 110 patients (age range, 10.8 +/- 4.9 [SD] years) who had preoperative PSG, and 18 patients (age range, 4.0 +/- 2.9 [SD] years) who had preoperative IPFT prior to undergoing any type of scoliosis repair by the Children's Hospital of Los Angeles Division of Orthopedic Surgery from January 1990- July 2001. The following information was reviewed and correlated: preoperative PSG parameters (baseline and nadir S(aO(2) ), baseline and peak P(ETCO(2) ), and apnea hypopnea index [AHI]), preoperative IPFT parameters (respiratory system compliance [C(rs)], respiratory system resistance [R(rs)], tidal volume [V(T)], and FRC), and length of postoperative MV. Twenty-seven patients (25%) who had PSG and 5 patients (28%) who had IPFT required postoperative MV >3 days. There was no association between baseline and nadir S(aO(2) ) 相似文献   

肥胖阻塞型睡眠呼吸暂停综合征患者肺功能、酸反流及食管动力学特点分析

目的探讨肥胖合并阻塞型睡眠呼吸暂停综合征（OSAS）患者的肺功能、酸反流以及食管动力学特征。 方法回顾性分析2019年3月至2019年12月于新疆维吾尔自治区人民医院呼吸与危重症医学中心住院治疗的82例肥胖患者的临床资料。经多导睡眠监测（PSG）确诊并符合OSAS诊断标准的患者,进一部分为OSAS组（n=42例）和非OSAS组（n=40例）。收集患者的肺功能,GERD问卷调查,24 h pH检测以及食管动力学检测结果,分析各因素在OSAS发生中的特点。 结果经PSG分析发现,OSAS组呼吸暂停低通气指数高于非OSAS组,其最低动脉血氧饱和度（SaO₂%）低于非OSAS组,差异具有统计学意义（t=1.979,1.853;P＜0.05）。OSAS组用力肺活量（FVC）和第一秒用力呼气容积（FEV₁）显著低于非OSAS组,而功能残气量（FRC）明显高于非OSAS组,差异均具有统计学意义（t=2.012,1.964,1.883;P＜0.05）。OSAS组睡眠障碍者显著高于非OSAS组,且差异具有统计学意义（F=5.628,P＜0.05）;24 h食管pH检测显示,OSAS组酸反流次数、总酸反流次数及DeMeester评分均显著高于非OSAS组,差异具有统计学意义（t=3.157,4.102,5.213;P＜0.05）。OSAS组LES静息压力低于非OSAS组;UES静息压力高于非OSAS组,差异具有统计学意义（t=2.114,1.915;P＜0.05）。 结论肥胖患者中OSAS与肺功能改变、酸反流及食管动力异常有关,三者互为促进,相互影响。     

Abnormal systolic and diastolic myocardial function in obese asymptomatic adolescents

Structural and functional cardiac changes are known in obese adults. We aimed to assess the relationship between body mass index (BMI) and cardiac function in overweight and obese asymptomatic adolescents.     

支气管哮喘儿童肺功能检测与评价

目的探讨肺功能检测在儿童支气管哮喘诊治中的重要性及其各项参数指标的意义。方法采用意大利科时迈公司PONY FX肺功能仪,分别于急性发作期和缓解期检测支气管哮喘儿童肺功能指标,并进行对比分析。结果急性发作期大气道与小气道均存在不同程度的阻塞情况,缓解期大气道阻塞可逆性恢复,而小气道持续存在功能障碍。结论肺功能检测,尤其是小气道功能在儿童支气管哮喘的诊断、分级治疗、疗效评估和预后推测等方面具有重要价值。     

不同严重程度的阻塞性睡眠呼吸暂停低通气综合征患者的肺功能分析

目的研究不同严重程度的阻塞性睡眠呼吸暂停低通气综合征患者的肺功能变化。方法选取于我院因打鼾、白天嗜睡、夜间呼吸暂停就诊的患者,共184例,所有人均行肺功能、多导睡眠图(PSG)检查,根据呼吸暂停低通气指数(AHI)分为4组:对照组49例(AHI<5)、轻度组37例(5≤AHI<15)、中度组43例(15≤AHI<30)、重度组55例(AHI≥30)。分析各组肺活量(VC)实/预、补呼气量(ERV)、功能残气量(FRC)、第1秒呼气量(FEV 1)实/预、1秒率(FEV 1/FVC%)、最大呼气中期流速(MMEF)实/预%、50%肺活量流速(FEF 50%)实/预%、75%肺活量流速(FEF 75%)实/预%、肺总量(TLC)实/预、一氧化碳弥散量(TLCO)实/预%、最大自主通气量(MVV)、残气量/肺总量(RV/TLC)等指标。结果重度组MMEF实/预%、FEF 50%实/预%、FEF 75%实/预%、ERV、FRC明显低于中度组,中度组上述指标较轻度组降低,轻度组低于对照组,差异均有显著的统计学意义(P<0.05),而VC实/预%、FEV 1实/预%、FEV 1/FVC%、TLC实/预%、DLCO实/预%、RV/TLC%、MVV各组之间差异无统计学意义(P>0.05);此外MMEF实/预%、FEF 50%实/预%、FEF 75%实/预%与AHI、LAT呈负相关,与LSaO 2呈正相关;ERV、FRC与BMI呈负相关。结论OSAHS患者存在小气道功能损害,且其受损程度与夜间睡眠紊乱程度呈正相关。     

组织多普勒评价健康肥胖女性左右心室功能

目的 探讨组织多普勒成像(TDI)技术评价我国健康肥胖女性左、右心室功能改变.方法 选择健康肥胖成年人140例,其中女性80例,以TDI技术测量其在二、三尖瓣瓣环收缩期、舒张早期和晚期峰值运动速度(Sm、Em和Am)和Em/Am,并计算各指标平均值(MSm、Mem、Mam和Mem/Am).结果 肥胖组和正常对照组在二、三尖瓣瓣环各取样点Sm、Em、Em/Am以及MSm、Mem、Mem/Am减低,Am、Mam升高.肥胖女性体重增加心功能进一步减低.肥胖女性较男性心功能减低更明显.结论 TDI技术显示成年健康肥胖女性左、右心室功能已出现异常改变,为肥胖女性左、右心室局部和整体功能的早期评价提供了理想的检测手段.