张学菊 冯利鹤 刘万胜

[摘要] 目的 探讨无创通气治疗儿童阻塞性睡眠呼吸障碍的临床效果。 方法 方便选取2014年12月—2016年12月该院经多导睡眠仪监测诊断为阻塞性睡眠呼吸暂停低通气综合征的腺样体扁桃体肥大患儿25例，采用无创通气治疗。所有患儿在采用无创通气治疗后再采用多导睡眠仪监测，将治疗前后患儿的呼吸参数变化进行配对检验。 结果15例患儿在术前采用经鼻持续正压通气，术中无麻醉并发症，术后无拔管困难。治疗前，患儿AHI指数为（50.4±25.5）/h，OAI为（18.2±16.9）/h，ODI为（34.9±29.5）/h，最低血氧饱和度为（56.1±24.9）%。治疗后，患儿呼吸暂停和打鼾消失，呼吸费力减轻，日间精神状态得到明显改善。经实验室指标发现，阻塞性呼吸暂停指数、最低血氧饱和度、氧减指数、呼吸暂停低通气指数与治疗前相比均得到明显好转，差异有统计学意义（P<0.05）。 结论 无创通气治疗在儿童阻塞性呼吸睡眠障碍治疗中取得了良好的临床效果，患儿呼吸暂停低通气指数得到明显好转。

[关键词] 无创通气治疗；阻塞性呼吸睡眠障碍；慢性呼吸衰竭；临床效果

[中图分类号] R766 [文献标识码] A [文章编号] 1674-0742（2018）01（a）-0004-03

Noninvasive Ventilation in the Treatment of Obstructive Sleep Apnea in Children

ZHANG Xue-ju， FENG Li-he， LIU Wan-sheng

Department of Pediatrics， Laiwu Steel Group Hospital， Laiwu， Shandong Province， 271126 China

[Abstract] Objective This paper tries to investigate the clinical effect of noninvasive ventilation in the treatment of obstructive sleep apnea in children. Methods Convenient selected a total of 25 children with adenoid tonsil hypertrophy diagnosed by obstructive sleep apnea hypopnea syndrome in our hospital from December 2014 to December 2016 were treated with noninvasive ventilation. All children were treated with noninvasive ventilation and then monitored by multi - sleep monitor. The changes of respiratory parameters were matched before and after treatment. Results nasal continuous positive pressure ventilation was used in 15 cases before operation. There was no anesthesia complication during the operation and no difficulty in extubation after operation. Before treatment， the AHI index of children was （50.4±25.5） /h， OAI was （18.2±16.9） /h， ODI was （34.9±29.5） /h， and the lowest oxygen saturation was （56.1±24.9）%. After treatment， apnea and snoring disappeared， breathing effort reduced， and daytime mental status improved significantly. The laboratory indicators found that obstructive apnea index， minimum oxygen saturation， oxygen desaturation index， apnea hypopnea index were significantly improved compared with before treatment， the difference was statistically significant（P<0.05）. Conclusion Noninvasive ventilation has achieved good clinical results in the treatment of obstructive sleep apnea in children， and apnea hypopnea index in children has been improved significantly.

[Key words] Noninvasive ventilation treatment； Obstructive sleep apnea； Chronic respiratory failure； Clinical effect

無创通气治疗是无需建立人工呼吸道，对患者进行呼吸支持治疗的一种通气治疗方式，主要在各种慢性和急性呼吸衰竭疾病的治疗中加以应用。目前在对睡眠呼吸障碍疾病治疗中主要采用无创呼吸机治疗，这也是对成人阻塞性睡眠呼吸暂停综合征治疗的一种重要手段[1]。而儿童采用无创通气则可以针对阻塞性睡眠呼吸暂停综合征（OSAHS）进行有效治疗，同时还可以治疗因各种原因所导致的儿童呼吸功能不全等疾病，避免建立人工呼吸道，从而减少对患儿身心造成创伤，也大大减少了气管插管并发症问题发生[2]。……