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目的探讨阻塞性睡眠呼吸暂停综合征(OSAHS)并肺动脉高压患儿的围术期处理方案。方法回顾性分析2006年4月至2009年5月广州儿童医院收治的2例OSAHS并肺动脉高压患儿的临床资料并复习相关文献。1例患儿在肺动脉高压未纠正前接受传统方法扁桃体剥离联合腺样体刮除手术,1例患儿术前进行持续正压通气治疗,纠正肺动脉高压后接受等离子双扁桃体切除联合腺样体消融手术。结果术前纠正肺动脉高压患儿手术顺利,术中及术后未出现任何并发症,术前未纠正肺动脉高压患儿术后反复出现严重低血氧症,导致不能正常拔除气管插管,在重症监护室2d后才转入普通病房。对2例患儿进行3个月以上随访,睡眠打鼾、张口呼吸、憋气均明显改善,呼吸暂停指数术前分别为90.0、29.2,术后为3.5、4.6;夜间最低血氧饱和度0.43、0.63,手术后为0.95、0.92,取得了满意的效果。结论伴扁桃体腺样体肥大的OSAHS患儿,手术是一线治疗方案,但OSAHS并肺动脉高压患儿手术风险大,并发症出现率高,围术期处理非常重要,持续正压通气治疗可纠正患儿肺动脉高压,从而提高手术安全性。
Objective To investigate the perioperative management of obstructive sleep apnea syndrome (OSAHS) and pulmonary hypertension in children. Methods The clinical data of 2 OSAHS patients with pulmonary hypertension treated in Guangzhou Children’s Hospital from April 2006 to May 2009 were reviewed retrospectively and the related literatures were reviewed. One patient had tonsillectomy combined with adenoidectomy before pulmonary hypertension was uncorrected. One patient underwent continuous positive pressure ventilation before surgery. After correction of pulmonary hypertension, plasma bi-tonsillectomy combined with adenoid ablation surgery. Results Preoperative correction of pulmonary hypertension in children with smooth operation, no complications during and after surgery, preoperative uncorrected children with pulmonary hypertension recurrence of severe hypoxemia, leading to not be normal removal of the tracheal intubation, severe disease Care room after 2d transferred to the general ward. The follow-up of 2 patients with more than 3 months showed significant improvement in sleep snoring, mouth breathing and suffocating. The apnea index was 90.0 and 29.2 respectively after operation, and 3.5 and 4.6 after operation respectively. The lowest night oxygen saturation was 0.43 and 0.63 , 0.95,0.92 after surgery, and achieved satisfactory results. Conclusions Surgery is the first-line treatment for OSAHS patients with tonsil adenoid hypertrophy. However, children with OSAHS and pulmonary hypertension have a high surgical risk and high incidence of complications. Perioperative management is very important. Continuous positive pressure ventilation can correct the problem Pulmonary hypertension, thereby enhancing surgical safety.