背景:腺样体和腭扁桃体,淋巴组织的一部分,充当保护下气道和胃肠道的第一道防线。儿童腺样体扁桃体肥大可能导致气道阻塞。本研究旨在证明腺样体扁桃体肥大与血氧饱和度降低之间的关联。
方法:在7-12岁患有腺体扁桃体肥大和阻塞性症状的儿童中进行了一项回顾性队列研究。入住法哈德国王医院和米沙里王子医院,沙特阿拉伯,2023年7月至2024年1月之间的扁桃体切除术。排除标准包括呼吸系统疾病,心脏病,鼻息肉,鼻中隔偏曲,胸壁异常,和下气道疾病。对照组包括56名健康儿童。耳鼻喉科医师使用扁桃体大小确定气道阻塞的严重程度。使用脉搏血氧饱和度测量氧饱和度。使用多元线性回归评估氧饱和度的决定因素,显著性设置为p<0.05。
结果:该研究包括357名参与者,年龄分布在7-9岁(49.6%)和10-12岁(50.4%)之间,52%的男性。诊断包括腺样体肥大(30%),扁桃体肥大(35%),这两个条件(19%),对照组(16%)。扁桃体大小范围从1级(48%)到4级(8.4%),17%正常。腺样体扁桃体肥大组的氧饱和度中位数为96.0%,对照组为99.0%。各组氧饱和度有显著差异(p<0.0001),肥大组的中位饱和度低于对照组。男性的氧含量低于女性(估计值:-0.338,95%CI[-0.640,-0.036],p=0.028)。腺样体肥大(估计值:-3.863,95%CI[-5.241,-2.484],p<0.001),扁桃体肥大(估计值:-3.631,95%CI[-5.053,-2.208],p<0.001),并且同时具有两种条件(估计值:-3.777,95%CI[-5.3.7,-2.247],p<0.001)与较低的氧饱和度有关。1级扁桃体大小与氧饱和度增加相关(估计值=2.905,95%CI[1.616,4.194],p<0.001)。相比之下,4级扁桃体大小与较低的氧饱和度有关(估计值=-4.848,95%CI[-6.367,-3.329],p<0.001)。2级和3级与氧饱和度的变化没有显着相关。
结论:扁桃体肥大与儿童血氧饱和度降低和相关心肺并发症显著相关。早期腺样体扁桃体切除术可能有利于预防这些并发症和提高氧饱和度。
BACKGROUND: The adenoids and palatine tonsils, part of the lymphoid tissue, act as a first line of defense protecting the lower airways and gastrointestinal tract. Adenotonsillar
hypertrophy in children may lead to airway obstruction. This study aims to demonstrate the association between adenotonsillar
hypertrophy and decreased blood oxygen saturation.
METHODS: A retrospective cohort study was conducted among children aged 7-12 years with adenotonsillar hypertrophy and obstructive symptoms, admitted to King Fahad Hospital and Prince Mishari Hospital, Saudi Arabia, for tonsillectomy between July 2023 and January 2024. Exclusion criteria included respiratory diseases, cardiac disease, nasal polyps, nasal septum deviation, chest wall abnormality, and lower airway diseases. The control group included 56 healthy children. An otolaryngologist determined the severity of airway obstruction using the tonsil size. Oxygen saturation was measured using pulse oximetry. The determinants of oxygen saturation were assessed using multiple linear regression, with significance set at p<0.05.
RESULTS: The study included 357 participants, with an even age distribution between 7-9 years (49.6%) and 10-12 years (50.4%), and 52% males. Diagnoses included adenoid
hypertrophy (30%), tonsil
hypertrophy (35%), both conditions (19%), and the control group (16%). Tonsil sizes ranged from Grade 1 (48%) to Grade 4 (8.4%), with 17% normal. The median oxygen saturation was 96.0% for the adenotonsillar
hypertrophy group and 99.0% for the control. Oxygen saturation levels differed significantly across groups (p<0.0001), with lower median saturation in hypertrophy groups than controls. Males had a lower oxygen than females (estimate: -0.338, 95% CI [--0.640, -0.036], p=0.028). Adenoid
hypertrophy (estimate: -3.863, 95% CI [-5.241, -2.484], p<0.001), tonsil
hypertrophy (estimate: -3.631, 95% CI [-5.053, -2.208], p<0.001) and having both conditions (estimate: -3.777, 95% CI [-5.3.7, -2.247], p<0.001) was associated with lower oxygen saturation. Grade 1 tonsil size was associated with an increase in oxygen saturation (estimate = 2.905, 95% CI [1.616, 4.194], p<0.001). In contrast, Grade 4 tonsil size was linked to lower oxygen saturation (estimate=-4.848, 95% CI [-6.367, -3.329], p<0.001). Grades 2 and 3 were not significantly associated with changes in oxygen saturation.
CONCLUSIONS: Adenotonsillar hypertrophy is significantly associated with decreased blood oxygen saturation and related cardiopulmonary complications in children. Early adenotonsillectomy may be of benefit in preventing these complications and improving oxygen saturation levels.