儿童阻塞性睡眠呼吸暂停低通气综合征等离子

doi:10.6040/j.issn.1673-3770.0.2017.533

摘要/Abstract

摘要： 目的探讨儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)低温等离子消融术后并发症产生原因,总结并发症处理方案及预后。方法 2007年10月至2017年6月,行低温等离子消融手术的OSAHS患儿3 106例,均在全麻下行腺样体等离子消融术,伴或不伴扁桃体切除术。统计3 106例患儿中术后出血、发热、腭咽弓穿孔、鼻腔反流等并发症的患者数量,分析原因。结果 3 106例中术后出血76例(2.44%),再次全麻手术止血12例,手术止血后送PICU,原因为失血过多行输血治疗1例,止血术前麻醉时出现呕吐物窒息并抢救1例;术后1周内出现体温超过38.5 ℃的患儿44例,经对症处理后体温正常。术后患儿出现腭咽弓穿孔5例,因患者无症状未做特殊处理,穿孔自行愈合3例。腭瘘患者术后出现进食时鼻腔反流1例,经保守治疗后愈合。结论儿童OSAHS低温等离子消融术后并发症发生率较低,但如果处理不恰当可造成严重后果,甚至可危及患儿生命。临床上应注意预防并发症发生,妥善处理,尽量减轻并发症给患者带来的伤害。

关键词: 阻塞性, 低温等离子消融术, 并发症, 儿童, 睡眠呼吸暂停

Abstract: Objective To explore the causes of complications after low-temperature coblation surgery in children with obstructive sleep apnea-hypopnea syndrome(OSAHS), and to summarize the treatment and outcome of these complications. Methods The subjects were 3 106 patients with OSAHS who underwent low-temperature coblation adenoidectomy with or without tonsillectomy under general anesthesia in our department, between October 2007 and June 2017. We counted the number of patients with postoperative complications including postoperative bleeding, fever, perforation of palatopharyngeal arch, and nasal reflux, and analyzed the causes of complications. Results The postoperative bleeding rate was 2.44%(76/3 106). Twelve patients underwent reoperation for hemostasis under general anesthesia, 2 patients were sent to the pediatric intensive care unit, 1 required transfusion because of excessive blood loss, and another experienced choking during anesthesia. Forty-four patients showed fever in the week after the operation, with body temperatures higher than 38.5 ℃, but the temperatures were reduced to normal after symptomatic treatment. Pharyngopalatine arch perforation occurred in 5 cases, of which 3 were self-healing. One patient experienced nasal cavity reflux when eating because of a palatine fistula after the operation; this patient was healed after conservative treatment. Conclusion The complication rate for low-temperature coblation surgery is low in children with OSAHS, but if not handled properly, complications can cause serious, and even life-threatening, consequences. Therefore, we should try to prevent complications, to deal with them in a timely manner, and to minimize the damage they cause.

Key words: Sleep apnea, obstructive, Coblation, Complication, Children

中图分类号:

R766.7

仇书要,刘大波,钟建文,杨李强. 儿童阻塞性睡眠呼吸暂停低通气综合征等离子[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 34-37.

QIU Shuyao, LIU Dabo, ZHONG Jianwen, YANG Liqiang. Analysis of coblation complications in children with obstructive sleep apnea-hypopnea syndrome[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2018, 32(2): 34-37.

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