不同術式對阻塞性睡眠呼吸暫停綜合征患兒免疫功能的影響
[Abstract]:Background: obstructive sleep apnea-hypopnea syndrome (OSAHS) refers to the repeated partial or full obstruction of the upper airway in the process of sleep, resulting in insufficient ventilation and even apnea. It is a common sleep related respiratory disorder in children, which is mainly manifested in mouth breathing during sleep. It is accompanied by suffocation or even breathing difficulties, cognitive abnormalities such as daytime hyperactivity, learning difficulties, and aggressive behavior, and even pulmonary heart disease, such as respiratory and circulatory diseases, which are significantly different from adults in epidemiological and pathophysiological characteristics. Tonsillar and adenoid surgery can significantly improve OSAHS The disease is the preferred treatment for OSAHS in children, and continuous positive pressure ventilation, as a first-line treatment for adults, is only used in the perioperative period and in severe OSAHS children with 21- trisomy syndrome and severe malformation, but adenoids and tonsils are involved in the composition of the pharyngeal ring, especially for children. In recent years, the plasma tonsillectomy has been used in recent years for its mild response to pain and rapid recovery after operation. The operation can not only solve the problem of respiratory obstruction, but also retain the barrier function of the recess epithelium as far as possible. In the study of all forms of tonsillar adenoid related surgery, there is no agreement on the changes of immune function in children with OSAHS before and after operation. There are few studies on the therapeutic effect of different surgical methods on children's OSAHS. Objective: To study the simple adenoidectomy, adenoidectomy with tonsillectomy, The effects of adenoidectomy with all three kinds of tonsillectomy on the humoral and cellular immune function of children with OSAHS were used to explore the application of different surgical procedures and to provide a theoretical basis for the individualized clinical treatment. Methods: This study was a prospective clinical trial of.1. from 2014 to December 2014 for snoring or mouth breathing during sleep. 150 cases of children OSAHS diagnosed in Qilu Hospital of East University were diagnosed by polysomnography and were divided into simple adenoidectomy group (group A), adenoidectomy with tonsillectomy group (group B), adenoidectomy with all three groups of almond excision group (group C), 50 cases in each group of.2. were examined by PSG. After the next day and 6 months after the operation, the blood samples were collected and collected for 7:00-8:OOam. The Ig level and the percentage of T cell subgroups were detected in the laboratory. The complications were recorded at any time during the follow-up period of the record.3.. The pain degree was assessed by the Wong-Baker FACES pain score table in all the children after the operation, and 6 after the operation. At the end of the month, polysomnography was combined with clinical symptoms to determine the effect of the operation. The patients who did not do sleep monitoring were based on the improvement of clinical symptoms. At the same time, the effective rate of various kinds of surgical procedures was measured. Results: 1. compared with the preoperative, the level of immune indexes at 6 months after operation in the three groups was not statistically significant (P0 .05) first days after.2., second days, A, B, C three groups of pain scores increased in turn, the difference was statistically significant (P0.05), third days after the operation, A, B two no significant difference in pain score (P0.05), but obviously lower than C group (P0.05).3.A group 3 cases of flat peach body significantly increased (grade III), 2 cases of tonsils increased before surgery (II). C group had no tonsillar hyperplasia. Three kinds of effective probability were evaluated at 6 months after operation. According to clinical symptoms and PSG results, A, B, C three groups were 93.94%, 96.67%, 97.30%, respectively. Conclusion: adenoidectomy, adenoidectomy with tonsillectomy, adenoidectomy with all tonsillectomy There is no obvious effect on the humoral and cellular immune function of the children, and it can be achieved in the treatment of children's OSAHS. Simple adenoidectomy, adenoidectomy with partial tonsillectomy in children with low pain after surgery can consider the tonsil hypertrophy to determine the tonsils or not.
【學位授予單位】:山東大學
【學位級別】:碩士
【學位授予年份】:2016
【分類號】:R766.9
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