儿童OSAHS和变应性鼻炎的关系探讨

目的:探讨儿童OSAHS和变应性鼻炎的关系;方法:①通过病史、体征、变应原检测、鼻内镜检查、多导睡眠监测,对我科诊治的574例OSAHS患儿中变应性鼻炎的发病率进行了调查;②对78例接受正规抗过敏治疗3周以上的OSAHS伴变应性鼻炎患儿进行回顾性分析,总结疗效。结果:①574例OSAHS患儿中,258例(44.9%)被诊断为变应性鼻炎,占同期所有变应性鼻炎患儿的50.4%(258/512)。258例中,以持续性变应性鼻炎为主223例(86.4%);变应原以真菌属为主187例(72.5%),与其他组相比差异有统计学意义(P<0.05)。②接受正规抗过敏治疗3周以上的40例轻、中度OSAHS伴变应性鼻炎患儿,睡眠呼吸暂停现象消失,血氧饱和度达到92%以上,继续药物治疗维持疗效,有效率达100%。38例经正规抗过敏治疗的重度OSAHS伴变应性鼻炎患儿中,3例用药后有效,继续药物治疗维持疗效,其余患儿症状虽然有所减轻,睡眠中仍有呼吸暂停或低通气现象,LSaO2<92%,均行等离子系统腺样体切除,扁桃体部分切除加消融手术或扁桃体消融手术。结论:变应性鼻炎与儿童OSAHS存在密切关系,其中以持续性变应性鼻炎占大多数。变应原以真菌占首位,粉尘螨、屋尘螨为其次。对于轻、中度伴变应性鼻炎的OSAHS患儿,可以坚持抗过敏药物治疗,避免手术。对于重度患儿可以先抗过敏药物治疗,疗效不好再行手术。腺样体、扁桃体切除术后常规抗过敏治疗,方可预防变应性鼻炎所致的下鼻甲肥大或圆枕淋巴组织增生再次引起睡眠时低通气。

Correlation between allergic rhinitis and childhood obstructive sleep apnea-hypopnea syndrome

Objective:To investigate the correlation between allergic rhinitis and obstructive sleep apnea-hypopnea(OSAHS) syndrome in children.Method:①According to medical history,physical signs,skin-prick test,serum sIgE,endoscopic examination and polysomnography,the incidence of allergic rhinitis was confirmed in 574 cases of childhood obstructive sleeping apnea-hypopnea syndrome in our hospital between July in 2008 to June in 2010.②Effects of anti-allergic drugs were observed on 78 children with OSAHS and allergic rhinitis meanwhile.Result:①258 cases of allergic rhinitis were confirmed in 574 cases of OSAHS,accounting for 44.9% of the OSAHS cases and 50.4% of all cases of allergic rhinitis during the same period.Most of them were perennial allergic rhinitis(223 cases,86.4%),and 72.5% of them were aroused by fungal allergen.Compared with other allergen,statistically significant difference was found(P<0.05).②After receiving anti-allergic drugs regularly for 3 weeks,40 cases suffering from mild and moderate OSAHS and allergic rhinitis,3 cases out of 38 cases suffering from serious OSAHS and allergic rhinitis showed satisfactory results,while other cases had little improvement.Conclusion:Allergic rhinitis is closely related to childhood OSAHS,and perennial allergic rhinitis dominates.The most common allergen is fungal allergen,the second is house and flour dust mites.So for patients of mild and moderate OSAHS with allergic rhinitis,regular anti-allergic drugs can lighten OSAHS effectively and may make patients avoid surgery.Severe OSAHS cases can receive surgical intervention if prior anti allergic therapy fails.Anti allergic therapy should be adopted routinely after tonsillectomy and adenoidectomy in case of hypopnea due to hypertrophy of inferior turbinate or tubal torus in allergic rhinitis.