低温等离子腺样体切除联合双侧扁桃体方案治疗儿童鼾症的疗效及其影响因素研究

目的 探讨低温等离子腺样体切除联合双侧扁桃体方案治疗儿童鼾症的疗效及其影响因素研究。 方法 选取鼾症患儿110例作为研究对象，按照随机数字表法分为对照组与观察组，各55例。观察治愈率及总有效率，对比术前、术后1个月、6个月的免疫球蛋白A(immunoglobulin A，IgA)、免疫球蛋白G(immunoglobulin G，IgG)、免疫球蛋白M(immunoglobulin M，IgM)。评估术前、术后7 d的呼吸暂停低通气指数（apnea hypopnea index，AHI）、夜间最低氧饱和度［minimum blood oxygen saturation，LSa(O2）］及儿童睡眠问卷(pediatric sleep questionnaire,PSQ)评分。 结果 观察组的总有效率高于对照组，且治愈率高于对照组（P＜0.05）。观察组手术时间、术中出血量、术后疼痛时间及症状缓解时间均低于对照组（P＜0.05）。2组IgA、IgG、IgM均随着时间增加，术后1个月、6个月，观察组的IgA、IgG、IgM高于对照组（P＜0.05）。2组IgA、IgG、IgM在组间，时点间，组间时点间交互作用比较差异有统计学意义（P＜0.05）。简单效应LSD-t成对比较显示，术前2组IgA、IgG、IgM、AHI、LSa(O2）及PSQ评分比较，差异无统计学意义（P＞0.05）；术后1个月、6个月，观察组的IgA、IgG、IgM高于对照组（P＜0.05）。术后7 d，观察组的AHI低于对照组，而LSa(O2）、PSQ评分高于对照组（P＜0.05）。治愈/显效组与有效/无效组在性别、年龄、病程、体重、术前IgA、术前IgG、术前IgM、术前AHI、术前LSa(O2）、术前PSQ评分比较中，差异无统计学意义（P＞0.05）；而在手术方法比较中差异有统计学意义（P＜0.05）。logistic回归分析显示，动力切割系统切除腺样体联合常规剥离双侧扁桃体手术是影响儿童鼾症治疗效果的独立危险因素（P＜0.05）。 结论 低温等离子腺样体切除联合双侧扁桃体切除治疗小儿鼾症效果显著，不仅对免疫功能影响小，并且能改善患者通气功能。

Therapeutic effect of low-temperature plasma adenoidectomy combined with bilateral tonsil regimen in the treatment of pediatric snoring and its influencing factors

Objective To explore the effect of low-temperature plasma adenoidectomy combined with bilateral tonsil regimen in the treatment of pediatric snoring and its influencing factors.Methods In total, 110 children with snoring were selected as the research subjects. According to the random number table method, they were divided into the control group and the observation group, with 55 cases in each group. The cure rate and total effective rate were observed, and the immunoglobulin A(IgA), immunoglobulin G(IgG), and immunoglobulin M(IgM) were compared before surgery, and at 1 and 6 months after surgery. The apnea hypopnea index(AHI), minimum blood oxygen saturation［LSa(O2)］ and pediatric sleep questionnaire(PSQ) scores before and at 7 d after surgery were assessed.Results The total effective rate and cure rate of the observation group were higher than those of the control group(P＜0.05). The duration of operation, intraoperative blood loss, duration of postoperative pain and symptom relief time in the observation group were shorter or less than those in the control group(P＜0.05). The levels of IgA, IgG, and IgM in both groups increased with time, which were higher in the observation group than in the control group at 1 month and 6 months after surgery(P＜0.05). There were statistically significant differences in the interaction between groups, time points and time points between groups with respect to IgA, IgG and IgM(P＜0.05). Simple effect LSD-t pairwise comparison showed that there was no significant difference in IgA, IgG, IgM, AHI, LSa(O2) and PSQ scores between two groups before surgery(P＞0.05); at 1 month and 6 months after surgery, IgA, IgG, and IgM in the observation group were higher than those in the control group(P＜0.05). At 7 d after surgery, the AHI of the observation group was lower than that of the control group, while the LSa(O2) and PSQ scores were higher than those of the control group(P＜0.05). There was no difference in gender, age, course of disease, weight, preoperative IgA, preoperative IgG, preoperative IgM, preoperative AHI, preoperative LSa(O2), and preoperative PSQ scores between the cured/markedly effective group and the effective/ineffective group(P＞0.05), while there was significant significance in comparison of surgical methods(P＜0.05). Logistic regression analysis showed that adenoidectomy with the power cutting system combined with conventional bilateral tonsillectomy was an independent risk factor affecting the therapeutic effect of pediatric snoring(P＜0.05).Conclusion Low-temperature plasma adenoidectomy combined with bilateral tonsillectomy is effective in the treatment of pediatric snoring. It not only has a little impact on the immune function, but also improves the ventilation function of the patient.