对比芬太尼试验与简明儿童OSAS量表识别重度阻塞性睡眠呼吸暂停综合征(OSAS)的价值

 目的 对比分析芬太尼试验与简明儿童OSAS量表（简称量表）识别重度阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome，OSAS）的价值，寻找一种简便可靠的方法指导扁桃体伴腺样体切除术患儿围术期阿片类药物的使用。方法 前瞻性选择复旦大学附属儿科医院2018年6—11月期间择期行扁桃体伴腺样体切除术并于术前完成多导睡眠监测（polysomnography，PSG）的连续病例102例，由不知晓PSG诊断结果的医生指导监护人于术前填写中文版筛查量表；由不知晓PSG以及量表诊断结果的麻醉医生于麻醉诱导后进行芬太尼试验。对照PSG诊断结果，分析芬太尼试验诊断重度OSAS的价值，并与量表进行比较。结果 102例手术患儿中46例为重度OSAS，量表诊断32例，灵敏度69.6%，特异度76.8%，阳性预测值71.1%，阴性预测值75.4%，准确度73.5%；芬太尼试验诊断40例，灵敏度87.0%，特异度87.5%，阳性预测值85.1%，阴性预测值89.1%，准确度87.3%，各项指标差异均有统计学意义（P<0.05）。量表诊断重度OSAS的ROC曲线下面积为0.788（95% CI：0.696~0.863），芬太尼试验诊断重度OSAS的ROC曲线下面积为0.908（95% CI：0.835~0.957），差异有统计学意义（P<0.05）。结论 芬太尼试验对于重度OSAS具有较好的诊断价值，可作为一种简便实用的方法代替PSG指导扁桃体伴腺样体切除术患儿围术期阿片类药物的使用。

Comparison of fentanyl test and the short pediatric OSAS scale in identifying severe obstructive sleep apnea syndrome

Objective To compare and analyze the value of fentanyl test and the short pediatric OSAS scale in identifying severe obstructive sleep apnea syndrome (OSAS),and to find a simple and reliable method to guide the perioperative use of opioids in children undergoing adenotonsillectomy. Methods A total of 102 children undergoing elective adenotonsillectomy in Children's Hospital,Fudan University from Jun.2018 to Nov.2018 were prospectively selected.The Chinese version of OSAS screening scale was filled in by guardians instructed by a doctor blinded to the results of polysomnography (PSG) before surgery.Fentanyl test was performed after induction of anesthesia by an anesthesiologist blinded to the results of PSG and the scale.Compared with the diagnostic results of polysomnography,the value of the short pediatric OSAS scale and fentanyl test in identifying severe OSAS were assessed. Results Fouty-six of 102 children were severe OSAS,of which 32 were diagnosed by the short pediatric OSAS scale with sensitivity of 69.6%,specificity of 76.8%,positive predictive value of 71.1%,negative predictive value of 75.4% and accuracy of 73.5%,and 40 by fentanyl test with sensitivity of 87.0%,specificity of 87.5%,positive predictive value of 85.1%,negative predictive value of 89.1% and accuracy of 87.3%.The difference was statistically significant (P<0.05).The area under the ROC curve for the short scale was 0.788 (95% CI:0.696-0.863) and 0.908 (95% CI:0.835-0.957) for fentanyl test,the difference was statistically significant (P<0.05). Conclusions Fentanyl test has a better performance in identifying severe obstructive sleep apnea syndrome.It can be used as a simple and practical method to replace polysomnography to guide the perioperative use of opioids in children undergoing adenotonsillectomy.