目的:对肺动脉收缩压(PASP)的变化进行病例系列分析,鼻吸气流量(NIF),上气道容积,阻塞性呼吸暂停/低通气指数(OAHI),阻塞性睡眠呼吸暂停儿童(OSA)腺样体扁桃体切除术(T&A)后的上颌下颌三维(3D)形态。
方法:回顾性评估2012年至2020年在医院口腔呼吸转诊中心筛查的1002名儿童的档案。从这个宇宙中,15名阻塞性睡眠呼吸暂停儿童(7名女性;8名男性),年龄4.1至8.9岁(平均年龄5.4岁±1.3),选择有扁桃体切除术和/或腺样体切除术指征的患者.在T&A之前进行完整的基线检查(T0),在T&A之后进行第二次完整检查(T1)18.7个月的随访(范围从12到30个月)。11名患者被提交给T&A,4例患者有适应症,但未获得公共卫生系统的手术授权.根据OSA患者门诊的协议,多普勒超声心动图,多导睡眠图,鼻测压,在(T0)和(T1)进行计算机断层扫描成像。
结果:T&A后PASP下降16.6%。T&A儿童的NIF增加(40.3%)比非T&A儿童的NIF增加(16.8%)。T&A和非T&A儿童的上呼吸道容量增加,但在T&A患者的鼻咽部发现更大的体积增加(45.6%)。6名T&A儿童(55%)和3名非T&A儿童(75%)的OAHI没有变化。在六个T&A儿童(55%)和两个未经治疗的儿童(50%)中,上颌骨相对于颅底向下和向后移位。9名T&A儿童(85%)和3名未经治疗的儿童(75%)表现出广泛的髁突生长和下颌长度增加。定性3D评估显示T&A和非T&A患者的形态学3D变化相似。
结论:肺动脉收缩压降低,鼻吸气流量增加,腺样体扁桃体切除术后鼻咽体积增加,但手术和非手术患者的阻塞性呼吸暂停/低通气指数和上颌下颌形态相似。
OBJECTIVE: To perform a
case series analysis of the changes in the pulmonary artery systolic pressure (PASP), nasal inspiratory flow (NIF), upper airway volume, obstructive apnea/hypopnea index (OAHI), and the maxillomandibular three-dimensional (3D) morphology after adenotonsillectomy (T&A) of obstructive sleep apnea children (OSA).
METHODS: Retrospective assessment of files from 1002 children screened between 2012 and 2020 in a hospital-based mouth-breather referral center. From this universe, 15 obstructive sleep apnea children (7 females; 8 males), ages 4.1 to 8.9 years old (mean age of 5.4 years ± 1.3), who presented indications of tonsillectomy and/or
adenoidectomy were selected. The complete baseline examination (T0) was carried out before T&A and a second complete examination (T1) was made 18.7-month follow-up after T&A (ranging from 12 to 30 months). Eleven patients were submitted to T&A, and four patients had indications but did not receive authorization for surgery from the public health system. According to the protocol of the outpatient clinic for OSA patients, Doppler echocardiography, polysomnography, rhinomanometry, and computed tomography imaging was performed at (T0) and (T1).
RESULTS: PASP decreased 16.6% after T&A. NIF increased more in T&A children (40.3%) than in non-T&A children (16.8%). The upper airway volume increased in T&A and non-T&A children, but greater volumetric gain (45.6%) was found in the nasopharynx of T&A patients. OAHI did not change in six T&A children (55%) and three non-T&A children (75%). The maxilla displaced downward and backward relative to the cranial base in six T&A children (55%) and two untreated children (50%). Nine of the T&A children (85%) and three untreated children (75%) presented extensive condylar growth and increased mandibular length. The qualitative 3D assessment showed similar morphological 3D changes in T&A and non-T&A patients.
CONCLUSIONS: Pulmonary artery systolic pressure decreased, nasal inspiratory flow increased, and nasopharynx volume increased following adenotonsillectomy, but obstructive apnea/hypopnea index and maxillomandibular morphology were similar in surgical and non-surgical patients.