小儿鼾症手术联合下鼻甲后端消融术对鼻腔通气功能的影响

  目的  鼾症患儿病因多且复杂，部分患儿常规扁桃体及腺样体切除术后效果不佳，本研究将小儿鼾症手术与下鼻甲后端消融术联合应用，探讨其在改善鼻腔通气功能的应用价值。  方法  纳入蚌埠医学院第一附属医院耳鼻咽喉头颈外科于2021年6—12月期间收治的60例经过多导睡眠监测(PSG)确诊的小儿鼾症患儿，采用随机数字表法将患儿分为对照组(30例，行鼻内镜下低温等离子扁桃体切除及腺样体消融术)和实验组(30例，行鼻内镜下低温等离子扁桃体及腺样体切除联合下鼻甲后端消融术)。治疗前后均行PSG、鼻阻力测定及儿童阻塞性睡眠呼吸暂停低通气综合征特异性生活质量调查(OSA-18)量表填写。比较2组术前、术后6个月的睡眠呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO₂)相关水平及OSA-18量表总评分，2组中鼻阻力值异常患儿术后第1、2、3周的鼻阻力值。  结果  实验组患儿术后的AHI[(3.60±1.63)次/min]、LSaO₂[(96.07±2.29)%]指标及OSA-18总评分[(22.57±2.79)分]优于对照组[(8.63±1.30)次/min、(91.23±1.22)%、(25.57±4.71)分]，差异均有统计学意义(均P＜0.05)；术后第1周2组鼻阻力与术前相比均无明显改善(均P>0.05)，术后第2、3周2组鼻阻力均显著改善(均P＜0.05)，且实验组鼻阻力改善明显优于对照组(均P＜0.05)。  结论  鼻阻力异常患儿行鼻内镜下低温等离子扁桃体切除及腺样体消融联合下鼻甲后端消融术更有利于改善患儿术后鼻腔通气功能, 提高患儿生活质量。 

Influence of paediatric snoring combined with posterior inferior distribution of the ventilation function on nasal ventilation

  Objective  The causes of snoring in children are multiple and complex, and the effect of routine flat gland resection in some children is poor. This study will combine snoring surgery with posterior end ablation of inferior turbinate in children to explore its application value in improving nasal ventilation function.  Methods  A total of 60 children with severe snoring [obstructive sleep apnea (OSA)] diagnosed by polysomnography (PSG) in the Department of Otolaryngology and Head and Neck Surgery of the First Affiliated Hospital of Bengbu Medical College from June 2021 to December 2021 were selected and randomly divided into control group (30 cases, thermic tonsils under a nasal endoscopy and adenoid ablation) and experimental group (30 cases, underwent endoscopic low oil into nasal and adenoidectomy combined with ablation of the posterior end of the inferior tribute). Before and after treatment, PSG and nasal resistance were measured, and disease specific quality of life survey (OSA-18) for children with obstructive sleep apnea hypopnea syndrome (OSAHS) were completed. The AHI, LSaO₂ levels, OSA-18 scale scores, and nasal resistance values at 1, 2 and 3 weeks after surgery of children with abnormal nasal resistance value were compared between the two groups before surgery and 6 months after surgery.  Results  The AHI [(3.60±1.63) times/min], LSaO₂ indexes (96.07%±2.29%) and OSA-18 total score [(22.57±2.79) points] of the experimental group were better than those of the control group [(8.63±1.30) times/min, 91.23%±1.22% and (25.57±4.71) points], and the differences were statistically significant (all P < 0.05). No significant improvement in nasal resistance was observed in the first week after surgery (P>0.05), and the nasal resistance in the second and third weeks after surgery was significantly improved (all P < 0.05) compared with before surgery. In addition, the nasal resistance in the experimental group was significantly better than that in the control group (all P < 0.05).  Conclusion  Endoscopic low-temperature plasma tonsillectomy and adenoid ablation combined with posterior and inferior distribution of ablation in children with abnormal resistance are more conducive to improving post-operative function and quality of life.