發(fā)布時(shí)間：2018-10-19 16:26

【摘要】：目的:本次采用隨機(jī)對(duì)照法研究手術(shù)治療和藥物治療伴有呼吸相關(guān)睡眠障礙癥狀的腺樣體肥大的臨床療效,一方面希望為臨床腺樣體肥大規(guī)范化治療提供參考依據(jù),另一方面通過(guò)前瞻性研究藥物治療已有伴隨癥狀的腺樣體肥大的可行性,已期為臨床上推廣保守治療腺樣體肥大提供臨床依據(jù)。方法:實(shí)驗(yàn)研究對(duì)象選自我院門(mén)診自2016年1月初到2016年12月底臨床上診斷為伴呼吸相關(guān)睡眠障礙癥狀的中、高度腺樣體肥大生病兒童59例(所有研究對(duì)象病史均12周)。遵循隨機(jī)對(duì)照的原則分為三個(gè)實(shí)驗(yàn)組,其中A組即手術(shù)組(行氣靜復(fù)合麻醉后鼻內(nèi)鏡下腺樣體吸切術(shù))19例,B組即聯(lián)合用藥組(口服孟魯司特鈉+鼻用糠酸莫米松鼻噴劑)20例,C組即單獨(dú)藥物組(單一口服孟魯司特鈉)20例,治療時(shí)間3個(gè)月,比較三組研究對(duì)象治療前、后呼吸相關(guān)睡眠障礙癥狀問(wèn)卷調(diào)查總評(píng)分(依據(jù)改良后Bitar評(píng)分[1])、電子鼻咽鏡下腺樣體體積好轉(zhuǎn)率,采用計(jì)數(shù)資料卡方檢驗(yàn),計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差表示,進(jìn)行t檢驗(yàn)、卡方檢驗(yàn)等統(tǒng)計(jì)學(xué)檢驗(yàn),p0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:三組治療前呼吸相關(guān)睡眠障礙癥狀總評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義(F=0.511,P0.05),接受治療3個(gè)月后,三組呼吸相關(guān)睡眠障礙癥狀總評(píng)分差異有統(tǒng)計(jì)學(xué)意義(F=21.829,P0.05),A組較B、C組治療后總評(píng)分差異均有統(tǒng)計(jì)學(xué)意義(χ2=10.810,29.476,P0.017),腺樣體體積好轉(zhuǎn)率A組優(yōu)于B、C組。B組與C組治療后總評(píng)分差異有統(tǒng)計(jì)學(xué)意義(χ2=6.465,P0.017),腺樣體體積好轉(zhuǎn)率B組優(yōu)于C組。結(jié)論:手術(shù)治療和藥物治療伴呼吸相關(guān)睡眠障礙癥狀的中、高度腺樣體肥大,均可一定程度緩解生病兒童臨床癥狀,消除不良體征。手術(shù)治療療效最顯著,聯(lián)合藥物治療優(yōu)于單獨(dú)藥物治療。針對(duì)拒絕早期手術(shù)干預(yù)治療的生病兒童,優(yōu)先考慮聯(lián)合藥物保守治療3個(gè)月,若改善無(wú)效或有癥狀加重情況,仍建議及早接受手術(shù)治療。
[Abstract]:Objective: to study the clinical effect of adenoid hypertrophy with apnea associated sleep disorder by using randomized controlled method, in order to provide reference for the standardized treatment of adenoid hypertrophy. On the other hand, the feasibility of drug therapy for adenoid hypertrophy with symptoms has been studied prospectively, which provides clinical basis for the clinical application of conservative treatment of adenoid hypertrophy. Methods: the subjects of the study were 59 children with high adenoid hypertrophy who were clinically diagnosed as apnea associated sleep disorder from January 2016 to December 2016 (all the subjects' history was 12 weeks). According to the principle of random control, they were divided into three experimental groups. There were 19 cases in group A (adenoidectomy under nasal endoscope after combined anesthesia), 20 cases in group B (oral montelukast sodium for nasal use of amethasone furoate) and 20 cases in group C (single oral drug). 20 patients were treated with montelukast sodium. The duration of treatment was 3 months. The total score of questionnaire (based on improved Bitar score [1]) before and after treatment was compared between the three groups. The improvement rate of adenoid volume under electronic nasopharyngoscope was measured by chi-square test. The measurement data were expressed as mean 鹵standard deviation. T test, chi-square test and other statistical tests were performed, p0.05 was statistically significant. Results: there was no significant difference in the total score of the three groups before treatment (FV 0.511 P 0.05), but after 3 months of treatment, there was no significant difference in the total score of the three groups. There were significant differences in the total scores of respiratory related sleep disorders among the three groups (FF21.829P 0.05) compared with those in group C (P 0.017). The improvement rate of adenoid volume in group A was better than that in group B (P 0.017), and the difference in total score between group B and group C was significant (P < 0.05). The difference was statistically significant (蠂 2, 6.465, P 0.017). The improvement rate of adenoid volume in group B was better than that in group C. Conclusion: the moderate and high adenoid hypertrophy associated with apnea associated sleep disorder in surgical treatment and drug therapy can alleviate the clinical symptoms and eliminate the adverse signs in children with diseases. Surgical treatment is the most effective, combined drug therapy is better than the single drug treatment. For the sick children who refuse early surgical intervention, priority should be given to the combination of medication and conservative treatment for 3 months. If the treatment is ineffective or symptomatic exacerbation, it is still recommended to receive surgical treatment as early as possible.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R766.9

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