睡眠评估可帮助确定儿童扁桃体术后呼吸系统并发症

Performing polysomnography（多导睡眠图） (sleep study) prior to pediatric（小儿科的） adenotonsillectomy（增殖腺扁桃体切除术） (surgical removal of the tonsils扁桃体 and adenoids增殖腺) may help identify children at a higher risk of developing postoperative（手术后的） respiratory（呼吸的） complications, according to a report in the January issue of Archives of Otolaryngology（耳鼻喉科学） - Head Neck Surgery, one of the JAMA/Archives journals. "Pediatric adenotonsillectomy is a safe outpatient procedure; however, there is a subset of patients who do not meet the criteria for outpatient surgery," according to background information in the article. Guidelines for adenotonsillectomy, established by the American Academy of Otolaryngology—Head and Neck Surgery, recommend that children should be healthy, have no evidence of obstructive sleep apnea-hypopnea syndrome (recurring episodes of obstruction or collapse of the upper airway during sleep) and be older than 3 years.

To determine if polysomnography may potentially predict adverse outcomes following a pediatric adenotonsillectomy, Eric M. Jaryszak, M.D., of the George Washington University School of Medicine, Washington, D.C., and colleagues, examined the records of 1,131 children who underwent an adenotonsillectomy by two attending surgeons at an academic pediatric hospital.

Preoperative polysomnography was performed on 151 patients, representing 13.4 percent of all those undergoing adenotonsillectomy. Of these, 23 (15.2 percent) experienced adverse respiratory events after surgery. Results of the polysomnography showed that patients who experienced respiratory complications had significantly higher apnea-hypopnea index (provides an overall severity of sleep apnea including sleep disruptions or low levels of oxygen in the blood), higher hypopnea index (episodes of overly shallow breathing or abnormally low respiratory rates) and lower nadir（最低点） oxygen saturation（饱和） (the lowest level of oxygen saturation).

Additionally, the 23 individuals who experienced complications had a higher body mass index (BMI) compared with those who did not have complications, with 47.8 percent defined as obese, according to BMI criteria, versus 29.7 percent in the non-complication subgroup.

Overall, the patients who experienced adverse respiratory events spent an additional 22 days in the hospital beyond routine overnight observation for persons with obstructive sleep apnea-hypopnea（呼吸不足） syndrome.

"Polysomnographic data may potentially be used for predicting which patients are at higher risk for adverse respiratory events after adenotonsillectomy," the authors conclude. "Such knowledge is valuable in planning postoperative management and perhaps intraoperative（手术发生的） anesthesia management."