定量组织速度成像对阻塞性睡眠呼吸暂停低通气综合征患儿左心功能的研究

目的：应用定量组织速度成像（QTVI）评价阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿腺样体和（或）扁桃体切除术前、后左心功能变化，探讨儿童OSAHS对左心功能的影响及QTVI的临床应用价值，确定手术对儿童OSAHS的治疗作用。方法：根据AHI将经PSG确诊的55例扁桃体和（或）腺样体肥大的OSAHS患儿分为轻度、中度及重度组；39例中、重度OSAHS患儿接受腺样体和（或）扁桃体切除术，将其中25例术后随访6个月再行PSG及QTV1的患儿设为实验组；选取20名正常儿童为对照组，应用QTV1技术进行检测。结果：术前0SAHs中度及重度组Va高于对照组，重度组Ve／Va低于对照组，差异均有统计学意义（P〈0．05），Vs各组间差异无统计学意义（P〉0．05）。术后6个月AHI及Va均降低，与术前组比较差异有统计学意义（P〈0．05），与对照组比较差异无统计学意义（P〉0．05）。Ve／Va手术前后各组间差异无统计学意义（P〉0．05）。结论：中、重度OSAHS患儿早期有不同程度左室舒张功能下降，二尖瓣环QTVI技术参数能够敏感反映OSAHS患儿左心功能早期改变，在判断左心功能早期变化方面有重要价值。手术切除腺样体和（或）扁桃体是治疗儿童OSAHS的有效方法，可使心肌功能障碍发生逆转。

Quantitative tissue velocity imaging evaluation of left ventricular function in obstructive sleep apnea hypopnea syndrome in children

Objective： Quantitative tissue velocity imaging （QTVI） was employed to evaluate the changes of left ventricular function before and after adenoidectomy and/or tonsillectomy in children with obstructive sleep apnea hypopnea syndrome（OSAHS）, with the aim of which to investigate the influence on left ventricular function and clinical usefulness of QTVI, and to determine the therapeutical effect of operation in childhood OSAHS. Method：According to the condition of AHI, 55 children of OSAHS were divided into mild group, moderate group and severe group who were finally diagonosed with adenoid and/or tonsil hypertrophy by polysomnography （PSG）. Thirty-nine cases with moderate to severe OSAHS received adenoidectomy and/or tonsillectomy. Twentyfive cases of them were selected as experimental group who received the detections of PSG and QTVI again 6 monthes after the operation. Twenty cases of unimpaired children were selected as control group. All the enroll ment subjects were performed by OTVI. Result：Compared with control group, the late diastolic peak velocity （Va） were significantly higher in preoperative OSAHS of moderate and severe groups and the ratio of early diastolic peak velocity （Ve）/late diastolic peak velocity（Va） were significantly lower in that of severe groups （all P〈 0.05） ; while the systolic peak velocity（Vs） between two groups had no significantly difference （P〉0.05）. Postoperative AHI and the Va were significantly decreased compared to value of preoperative group （P〈0.05）, and there was no statistical difference between the value of postoperative and that of control group（P〉0. 05）. The ratio of Ve/Va were between preoperative group and preoperative group had no statistical difference（P〉0.05）. Conclusion：It is demonstrated that the left ventricular diastolic function of children with moderate to severe OSAHS decreased to varying degrees at early stage. Mitral annular velocity detecting by QTVI can be sensitive and useful in detecting the early changes of left ventricular function of children with OSAHS. Adenoidectomy and/or tonsillectomy were effective in treating childhood OSAHS, which could reverse myocardial dysfunction.