【摘要】 目的 探讨低温等离子扁桃体减容联合腺样体消融术治疗儿童鼾症的疗效。方法 选择2017年1月～2020年12月于安阳市妇幼保健院接受治疗的阻塞性睡眠呼吸暂停综合征（OSAS）82例患儿作为研究对象。采取随机数字表方法将全部患儿进行分组，对照组41例，观察组41例。对照组使用低温等离子扁桃体切除术联合腺样体消融术，观察组使用低温等离子扁桃体减容术联合腺样体消融术。对比两组患儿术后24 h的疼痛程度（VAS评分）、围手术期指标、术后应激反应指标、术后并发症情况、术前和术后1年的腺样体体积大小、术后1年的治疗效果、术前，术后以及术后1年的扁桃体体积大小。结果 观察组患儿在术后24 h的疼痛程度分级明显低于对照组（P<0.05）；手术出血量[（10.57±2.88）ml vs(28.11±4.75)ml]、手术时长[（14.70±4.08）min vs(20.89±4.81)min]、术后疼痛持续时间[（2.68±1.17）d vs(4.72±1.52)d]、术后住院时间[（1.43±0.26）d vs(1.75±0.42)d]均低于对照组（P<0.05）；术后24 h的皮质醇[（131.58±37.04）ng/ml vs(164.32±48.25)ng/ml]、促肾上腺皮质激素[（7.28±3.72）ng/ml vs(14.48±5.03)ng/ml]、中性粒细胞[（6.74±0.76）×109/L vs(7.85±0.82)×109/L]均低于对照组（P<0.05）。两组患儿均未出现严重的术后并发症。两组患儿术后1年和术前的腺样体体积比较，差异无统计学意义（t=0.644、-0.539,P均>0.05）。患儿术后1年的治疗效果对比，差异无统计学意义（Z=0.291,P>0.05）。观察组患儿扁桃体体积术后（4.08±0.85）ml和术后1年（4.01±0.79）ml明显低于术前（5.52±1.34）ml，差异有统计学意义（F=8.327,P<0.05）。结论 在儿童鼾症的治疗过程中，使用低温等离子扁桃体减容术联合腺样体消融术的操作方法可以有效改善患儿临床症状，同时获得术后短期内更好的恢复效果，具有良好的安全性。更多还原

【Abstract】 OBJECTIVE To investigate the effect of tonsillar volume reduction and adenoid ablation with low temperature plasma in the treatment of snoring in children. METHODS Eighty-two children with obstructive sleep apnea syndrome(OSAS) who were treated in Anyang Maternal and Child Health Hospital from January 2017 to December 2020were selected as the study subjects. All children were divided into control group(41 cases) and observation group(41 cases)by random number table. The children in the control group were treated with tonsillectomy combined with adenoid ablation by low-temperature plasma, while the children in the observation group were treated tonsillar volume reduction combined with adenoid ablation by low-temperature plasma. The pain degree(VAS score), perioperative indicators, postoperative stress response indicators, postoperative complications, adenoid volume before, after and one year after operation, treatment effect one year after operation, tonsil volume before, after and one year after operation between the two groups were compared.RESULTS The pain grade of children in the observation group at 24 hours after operation was significantly lower than that in the control group(P<0.05); The amount of operative bleeding [(10.57±2.88) ml vs(28.11±4.75) ml], the length of operative time [(14.70±4.08) min vs(20.89±4.81) min], the duration of postoperative pain [(2.68±1.17) d vs(4.72±1.52) d], and the length of postoperative hospitalization [(1.43±0.26) d vs(1.75±0.42) d] in the observation group were lower than those in the control group(P<0.05); The cortisol level [(131.58±37.04) ng/ml vs(164.32±48.25) ng/ml], adrenocorticotropic hormone level [(7.28±3.72) ng/ml vs(14.48±5.03) ng/ml], neutrophil level [(6.74±0.76)×109/L vs(7.85±0.82)×109/L] were lower than those in the control group(P<0.05). There were no serious postoperative complications in both groups. There was no statistically significant difference in adenoid volume between the two groups 1 year after operation and before operation(t=0.644,-0.539,P>0.05). There was no statistically significant difference in the treatment effect of children 1 year after operation(Z=0.291,P>0.05). The volume of the tonsils of the children in the observation group was significantly lower after surgery(4.08±0.85) ml and 1 year after surgery(4.01±0.79) ml than before surgery(5.52±1.34) ml, and the difference was statistically significant(F=8.327, P<0.05). CONCLUSION In the treatment of children’s snoring, the operation method of tonsil volume reduction combined with adenoid ablation by low-temperature plasma can effectively treat the children’s diseases, improve clinical symptoms, and obtain better recovery in a short time after operation, and with good safety.更多还原