鼻内镜下经口腺样体切割术

目的探讨鼻内镜用于经口腺样体切割术的可行性和优点。方法在鼻内镜和电视监视下经口行腺样体切割术60例,治疗由腺样体肥大引起的鼻窦炎、分泌性中耳炎和阻塞性睡眠呼吸暂停综合征。结果术后腺样体切割干净,无残体残留,鼻咽部结构显示良好,患者症状消失或明显减轻。结论该手术能在直视下进行,增加了手术安全性和准确性,病变切除更加彻底,手术疗效明显,并发症少。     

内镜下低温等离子射频消融术与电刀凝切术在小儿鼾症治疗中的应用分析

目的：比较低温等离子射频消融术与电刀凝切术在小儿阻塞性睡眠呼吸暂停低通气综合征（OSAHS）,扁桃体及腺样体切除术中的效果差异。方法：收治小儿鼾症患者80例,行双侧扁桃体及腺样体切除术,按手术方式：低温等离子射频消融术组（A组40例）,电刀凝切术组（B组40例）对比分析,两组的手术时间、术中出血量、术中镇痛药量、疼痛评分。结果：低温等离子射频消融术组（A组）的手术时间、术中出血量低于电刀凝切组（B组）,差异均有统计学意义（P〈0.05）;术后电刀凝切组（B组）疼痛评分高于等离子刀组（A组）,差异有统计学意义（P〈0.05）。结论：低温等离子射频消融术的疗效优于电刀凝切术,其能显著减少手术时间、术中出血量,且减轻术后疼痛。     

地氟烷在小儿扁桃体腺样体切除术中的应用及对躁动发生情况的影响

目的:探讨地氟烷在小儿扁桃体+腺样体切除术中的应用效果及对全身麻醉苏醒期躁动(EA)的影响。方法:选取2020年3月—2021年3月确诊并治疗的84例阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿,按数字表法随机分为对照组和观察组,每组42例。对照组使用七氟烷,观察组使用地氟烷。观察比较两组各时间点指标:手术时间(t_a)、麻醉时间(t_b)、恢复自主呼吸时间(t_c)、出现体动或睁眼时间(t_d)、拔管时间(t_e)、完全清醒时间(t_f)及停留麻醉后恢复室(PACU)时间(t_g);比较两组各个时间点下的小儿麻醉苏醒期躁动量化评分表(PAED)评分;比较两组的不良反应。结果:观察组t_d,t_e,t_f,t_g时间均低于对照组(P<0.05)。观察组拔管时(t₁)、拔管后5 min(t₂)PAED评分低于对照组(P<0.05)。两组不良反应比较,差异无统计学意义(P>0.05),且未发生皮肤瘙痒及呼吸抑制。结论:OSAHS患儿行扁桃体+腺样体切除术中使用地氟烷,可显著降低OSAHS患儿的PAED评分,缩短OSAHS患儿的PACU时间,且安全可靠。     

低温等离子刀辅助内镜下儿童扁桃体和腺样体切除术临床效果分析

目的:比较低温等离子刀辅助内镜下切除儿童扁桃体和腺样体(rT+A)和传统剥离法切除扁桃体、刮匙法刮除腺样体(cT+A)的手术效果差异.方法:47例扁桃体肥大伴腺样体肥大的患儿,其中24例采用rT+A术式,23例采用cT+A术式,采用t检验比较两组手术时间、术中出血量、术后疼痛时间和假膜脱落时间的差异.随访患儿手术前后听...     

BIS监测下盐酸右美托咪定对扁桃体、腺样体切除术患儿血流动力学的影响

目的探讨BIS监测下盐酸右美托咪定对扁桃体、腺样体切除术患儿血流动力学的影响。方法选择40例ASAⅠ级择期扁桃体、腺样体切除患儿,随机分为对照组和观察组,每组20例。2组患儿给予静注丙泊酚2 mg/kg+咪达唑仑0.1 mg/kg基础麻醉入睡后入室,监测心率(HR)、收缩压(SBP)、平均动脉压(MAP)、脑电双频谱指数(BIS)、血氧饱和度(Sp(O2))。观察组麻醉诱导前10 min泵入盐酸右美托咪定1μg/kg,继之以0.7μg/(kg·h)泵入;对照组于麻醉诱导前10 min泵等剂量生理盐水。2组麻醉诱导均静脉给予咪达唑仑0.1 mg/kg、丙泊酚2 mg/kg、苯磺酸顺势阿曲库铵0.2 mg/kg、舒芬太尼0.3μg/kg,快速诱导气管插管。观察组麻醉维持用右美托咪定0.7μg/(kg·h)、瑞芬太尼0.2μg/(kg·min)、丙泊酚2~4 mg/(kg·h)。对照组麻醉维持用瑞芬太尼0.2μg/(kg·min)、丙泊酚4~8 mg/(kg·h)。术中调整右美托咪定和丙泊酚泵入量,维持BIS值在50±5。记录基础值(t0)、插管即刻(t1)、上开口器即刻(t2)、手术结束(t3)、拔管即刻(t4)5个时间点的HR,MAP,BIS值及Sp(O2),计算心率收缩压乘积(RPP)。观察并记录手术结束呼吸恢复时间和拔管时间,计算术中丙泊酚用量。记录术后恶心呕吐、谵妄、躁动等不良反应发生情况。结果 HR:观察组t1,t4时点与t0时点相比均有显著升高(P均0.05),对照组t1~t4各时间点与t0比均显著升高(P均0.05);观察组t1~t4各时间点与对照组同时点相比均显著降低(P均0.05)。MAP:观察组t1,t3时点均比对照组对应时间点显著降低(P均0.05)。RPP:观察组t4时点比t0时点显著增高(P0.05),对照组t1~t4各时点均比t0时点显著增高(P均0.05);观察组与对照组同一时点比较差异均有统计学意义(P均0.05)。术后苏醒:与对照组比较,观察组呼吸恢复时间较短(P0.05),拔管时间较长(P0.05)。术中丙泊酚用量观察组显著低于对照组(P0.05)。术后谵妄、躁动发生率观察组显著低于对照组(P0.05)。结论小儿扁桃体、腺样体切除手术辅助应用盐酸右美托咪定镇静对患儿血流动力学影响小,术后谵妄、躁动发生率低,可有效减少丙泊酚用量,且可延迟拔管,利于术后呼吸管理。     

儿童腺样体切除术后原发性出血原因分析及治疗

目的 探讨儿童腺样体切除术后原发性出血的原因及治疗方法.方法 回顾性分析2007年1月至2008年12月在中国医科大学附属盛京医院耳鼻咽喉科行腺样体切除术患儿1523例的临床资料,统计术后原发性出血患儿病例资料,分析其发生原因并总结治疗方法.结果 1523例患儿中,共8例发生术后原发性出血,其中2例重新全麻止血,6例前鼻孔填塞高膨胀止血海绵止血,治疗后无再次出血.结论 儿童腺样体切除术后原发性出血主要原因有局部慢性炎症影响止血效果,手术止血不充分及创面过深,前鼻孔填塞高膨胀止血海绵及再次全麻止血是有效的止血方法.     

Age specific differences in pediatric obstructive sleep apnea

Background

Some have suggested that younger children have a more severe form of obstructive sleep apnea than older children and therefore are at a higher risk for respiratory compromise after tonsillectomy and adenoidectomy. However, at present there are few studies that have identified any significant correlation between age and severity of obstructive sleep apnea.

Objective

To determine if age specific differences in obstructive sleep apnea are present in children.

Design

Retrospective chart review.

Setting

Tertiary care children's hospital.

Patients

The records of children (1-18 years of age) with obstructive sleep apnea diagnosed by overnight polysomnography between January 1998 and January 2001 were reviewed. Children included in the study also had evidence of adenotonsillar hypertrophy and had no other co-existing medical problems.

Main outcome measures

Overnight polysomnography was performed in all children. Apnea-hypopnea index (AHI), baseline and lowest O₂ saturation, baseline and peak end tidal CO₂, and total number of obstructive apneas, hypopneas, central apneas and mixed apneas were measured during each polysomnogram. Children were subdivided into the following age groups: 1-2, 3-5, 6-11 and 12-18 years. Polysomnograms were classified into normal, mild, moderate and severe categories.

Results

Three hundred and sixty-three children were studied; 45 children were ages 1-2 years, 159 children were ages 3-5 years, 137 children were 6-11 years and 22 children were 12-18 years. Although there appears to be a trend towards a greater mean number of obstructive apneas, hypopneas, central apneas, mixed apneas, a higher mean AHI, lower mean SaO₂ nadir, and a higher mean PETCO₂ in the younger age groups when compared to the older groups, a Student's t-test demonstrates that there is no statistical significance for most OSA parameters. An analysis of variance using the F-test reveals statistical significance (p < 0.01) when children ages 1-2 were compared to those 3-5, 6-11 or 12-18 years of age for the variables AHI, mean number of central apneas, hypopneas and mixed apneas. When comparing patients in the various severity categories, children ages 1-2 years show a distinct distribution with a larger percentage in the moderate to severe categories. Chi square analysis reveals a significant difference between the frequency distribution of children in age group 1-2 years and that of the other age groups (p < 0.01).

Conclusion

There is a predilection for children less than 3 years of age to have more severe obstructive sleep apnea as documented by polysomnography. Central apnea also appears to be more common in this age group. These findings may be explained by anatomic and physiologic differences related to age and support a period of observation following adenotonsillectomy in younger children.     

腺样体切除联合置管术在小儿难治性分泌性中耳炎治疗中的应用研究

目的 探讨腺样体切除联合置管术应用于小儿难治性分泌性中耳炎的治疗效果.方法 选取上海交通大学医学院附属上海儿童医学中心2012年4月至2014年2月间入院治疗的小儿难治性分泌性中耳炎患者90例,应用随机数表法随机分为观察组45人和对照组45人.对照组使用低温等离子腺样体切除术;观察组则应用腺样体切除联合置管术治疗.统计两组患者治疗效果、炎性积液及并发症情况,按显效、有效和无效来评价患儿临床疗效,记录并统计参与试验患儿中耳炎性积液时间和听力损失、鼓膜穿孔等并发症情况.结果 临床疗效方面,观察组和对照组的治疗总有效率分别为91.11%和73.33%,两组差异具有统计学意义(χ2=8.631,P<0.05).观察组患儿中耳积液时间为7.63±1.27天短于对照组的11.78±1.75天,差异具有统计学意义(t=3.481,P<0.05).观察组治疗后中耳炎复发的比例(2.22%)比对照组(42.22%)低,差异具有统计学意义(χ2=9.165,P<0.05).两组并发症发生率分别为8.88%和40.00%,患儿鼓膜穿孔、化脓性中耳炎和听力损失等方面较对照组发生数明显更少,差异具有统计学意义(χ2=8.186,P<0.05).结论 腺样体切除联合置管术能够有效治疗小儿难治性分泌性中耳炎,改善临床症状,提高治疗有效率,应用效果良好,值得临床推广.     

腺样体切除合鼓室注射地塞米松治疗中耳炎50例临床观察

目的:比较腺样体切除与腺样体切除+鼓室注射地塞米松治疗儿童慢性分泌性中耳炎的疗效。方法:将50例(共82耳)腺样体肥大引起的分泌性中耳炎患儿随机分成治疗组(45耳)和对照组(37耳),全麻鼻内镜下行腺样体等离子切除术,并对治疗组鼓室内注射0.5~2ml地塞米松,所有患儿均随诊6个月,根据术后两组听力恢复情况进行疗效评定。结果:治疗组治愈38耳,有效5耳,无效2耳,总有效率为95.6%;对照组治愈28耳,有效3耳,无效6耳,总有效率为83.8%。治疗组疗效优于对照组,差异有统计学意义(P0.05)。结论:腺样体切除+鼓室注射地塞米松治疗腺样体肥大引起的儿童慢性分泌性中耳炎比单纯腺样体切除疗效好,值得临床推广应用。     

鼓室置管术治疗儿童分泌性中耳炎50例临床分析

目的探讨儿童分泌性中耳炎的有效治疗方法。方法对分泌性中耳炎的患儿经非手术治疗无效者,采用鼓室置管术及扁桃体、腺样体切除术。结果儿童分泌性中耳炎50例(89耳)1年左右中耳功能恢复正常,听力保持在25 dB以内达95%。结论鼓室置管及扁桃体、腺样体切除是治疗儿童分泌性中耳炎的有效方法。