家长警惕:儿童鼾症危害大!可能造成儿童生长发育迟缓 、腺样体面容、认知障碍......

2021-06-16 “交大二附院”公众号 “交大二附院”公众号

儿童鼾症,也就是我们平时所说的“打呼噜”,医学上称作儿童阻塞性睡眠呼吸暂停(OSA),表现为多种原因导致的睡眠时上气道反复塌陷或阻塞,出现响亮的鼾声和呼吸暂停,可继发生长障碍、潜在的或明显的神经认知功

关于儿童鼾症(OSA)治疗的问题

亲爱的各位家长:

儿童鼾症,也就是我们平时所说的“打呼噜”,医学上称作儿童阻塞性睡眠呼吸暂停(OSA),表现为多种原因导致的睡眠时上气道反复塌陷或阻塞,出现响亮的鼾声和呼吸暂停,可继发生长障碍、潜在的或明显的神经认知功能及心血管系统等并发症。OSA是儿童的常见病之一,发病率呈逐年上升的趋势,儿童肥大的扁桃体和增生的腺样体是OSA主要的病因。教育部办公厅2021年3月31日颁发了《关于进一步加强中小学生睡眠管理工作的通知》,在强调保证睡眠时间的同时,也指出要提高学生睡眠质量。充足的睡眠,特别是深度睡眠,对儿童和青少年的身心发育、智力提升、情绪行为以及记忆力的巩固都有非常重要的意义。

OSA作为最常见的儿童睡眠问题,对儿童有什么危害?有哪些治疗方法?就这些家长们关心的问题,今天小编就请西安交通大学第二附属医院耳鼻咽喉头颈外科病院的任晓勇教授做一解答,希望能帮助到被“小呼噜”困扰的家长们。

一、引起儿童OSA的主要原因

最常见的有两大原因:腺样体增生、扁桃体肥大。除了这两大原因之外,还有一些其他原因:过敏性鼻炎、肥胖、小颌畸形、舌体肥厚、其他。

在儿童OSA的诊断中,哪些临床症状和体征需要重点关注?

1、症状方面,关注有无打鼾以及打鼾的频率,其中打鼾≥3晚/周需要重点关注;

2、关注睡眠憋气、呼吸暂停、张口呼吸、呼吸费力、睡眠不安、遗尿、白天嗜睡、注意力缺陷或多动、学习成绩下降等表现。幼儿应关注张口呼吸、反复觉醒、情绪行为异常等。

3、在体征方面,关注腺样体肥大、扁桃体肥大、腺样体面容以及肥胖。

二、多导睡眠监测(PSG)

多导睡眠监测(PSG)是诊断OSA的金标准,是一项无创无痛性检查,在小儿体表不同部位用胶布粘贴相应电极,监测睡眠状态并进行数据采集,包括脑电、鼾声、血氧饱和度、口鼻气流、体位等相关参数,以此来判断睡眠情况、呼吸暂停及严重程度、缺氧情况等。

2020年新版指南推荐OAHI>1次/h作为儿童OSA的诊断界值,利于早期发现需要干预治疗的睡眠呼吸障碍患儿;另外AHI、OAI和最低血氧饱和度对儿童OSA的诊断也有重要参考意义。

三、儿童鼾症的危害

1、生长发育迟缓

呼吸不畅,夜间缺氧,导致内分泌紊乱,促生长激素分泌减少,影响长个子,时间长了就会比同龄孩子身形矮小体重偏轻或者过度肥胖。

2、认知障碍

严重的“打呼噜”会造成呼吸的暂时停止或者是通气不足,从而引起血液中氧含量的降低,可引起注意力不集中,反应迟钝,记忆力下降,学习困难,多动等认知障碍。有研究表明患有OSA的孩子较普通孩子学习成绩差。

3、颌面部发育异常

“打呼噜”时孩子长期的张口呼吸会造成下颌发育不良,出现下颌窄小、后缩,上唇短厚翘起、牙齿排列不整齐、上切牙突出、咬合不良等表现,医学上称为“腺样体面容”。长期,会影响孩子一生的面容。

4、中耳炎

小儿的咽鼓管具有“短、直、宽”的生理特点,肥大的腺样体如果堵塞了咽鼓管咽口会引起反复的渗出性中耳炎。这种情况长期存在,会明显影响孩子的听力,引起传导性耳聋。

5、其他系统功能障碍

如心血管系统、呼吸系统、内分泌系统等。

四、腺样体和扁桃体切除术

早发现、早诊断、早治疗!

确诊为OSA且临床检查符合腺样体和(或)扁桃体肥大的患儿,排除手术禁忌后,推荐腺样体和(或)扁桃体切除术作为中、重度OSA患儿的首选治疗。目前手术方式具有微创、出血少、损伤小、疼痛轻、恢复快等优点。

确诊为OSA患儿不符合腺样体和(或)扁桃体肥大时,需综合评估口腔、鼻腔等上气道情况,建议进一步行其他方法治疗。

全麻对儿童有影响吗?

麻醉技术发展至今已经非常成熟,对儿童身心发育并无不良影响。

全麻下手术可以消除患儿的恐惧心理,利于手术安全顺利进行,对于咽喉部位手术尤为重要。

术后免疫力会降低吗?

扁桃体腺样体在身体免疫系统中占得比重很小,由于病变原因切除并不会造成免疫功能降低。但是对3岁以下幼儿,除非非常必要,一般不选择手术切除。

需要指出的是,扁桃体虽然是人体的免疫器官,但不是最重要、也不是唯一的免疫器官,对于一些顽固的、严重的、引起并发症的扁桃体炎手术切除是利大于弊的。

孩子出现哪些症状要及时就诊?

★ 睡眠时打鼾或者出现憋气憋醒

★ 睡眠时张口呼吸、呼吸费力

★ 睡姿异常、睡眠不安

★ 白天嗜睡、注意力不集中

★ 学习困难、多动

★ 腺样体面容,出现上唇短厚翘起、牙齿排列★ 不整齐、咬合不良等

★ 夜间多汗、遗尿、磨牙等

★ 反复呼吸道感染

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    2021-06-18 neurowu
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    2021-06-16 潇洒熊

    学习了学习了!

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1981146, encodeId=21301981146e8, content=<a href='/topic/show?id=265e3e961ee' target=_blank style='color:#2F92EE;'>#发育迟缓#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37961, encryptionId=265e3e961ee, topicName=发育迟缓)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5fc9246, createdName=zhangfenasdf, createdTime=Sat May 07 06:34:09 CST 2022, time=2022-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1945792, encodeId=3e351945e9215, content=<a href='/topic/show?id=49ce6961069' target=_blank style='color:#2F92EE;'>#生长发育#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69610, encryptionId=49ce6961069, topicName=生长发育)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35a460, createdName=fengyi812, createdTime=Fri May 20 17:34:09 CST 2022, time=2022-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1347555, encodeId=66f8134e555aa, content=<a href='/topic/show?id=88713e938c1' target=_blank style='color:#2F92EE;'>#发育#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37938, encryptionId=88713e938c1, topicName=发育)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f4c124, createdName=neurowu, createdTime=Fri Jun 18 02:34:09 CST 2021, time=2021-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=974209, encodeId=6eef9e42093d, content=学习了学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210616/24667e82dc474d438cfa366d65717d99/09c14ce461ef4dbdafbcf576c83c288f.jpg, createdBy=d3135527069, createdName=潇洒熊, createdTime=Wed Jun 16 21:53:28 CST 2021, time=2021-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=974082, encodeId=aa3d9e408233, content=非常好, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210616/6ff069da45d748d78c33adba241d015f/697b0f8c6a5c4beea769c21778ab7e05.jpg, createdBy=c40a5526200, createdName=ms1000000595339481, createdTime=Wed Jun 16 13:44:06 CST 2021, time=2021-06-16, status=1, ipAttribution=)]
    2021-06-16 ms1000000595339481

    非常好

    0

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