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首页> 外文期刊>The Open Anesthesia Journal >Sleep Disordered Breathing May Signal Laryngomalacia
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Sleep Disordered Breathing May Signal Laryngomalacia

机译：睡眠呼吸障碍可能预示着喉头软化

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Background:Pediatric anesthesiologists are often confronted with children with sleep-disordered breathing (SDB) presenting for tonsillectomy and/or anesthesia. The typical patient has symptoms of obstructive sleep apnea (OSA) with enlarged tonsils; however, a subset of patients may have underlying laryngomalacia (LM) without tonsillar hypertrophy. Both OSA and LM significantly increase the risk of intra- and postoperative airway obstruction and sensitivity to narcotics. The prevalence of LM may be underestimated, because direct laryngoscopy (DL) is not routinely performed in the diagnostic evaluation of patients with SDB who lack tonsillar hypertrophy.Aim:To identify the prevalence and DL findings in pediatric patients with SDB without tonsillar hypertrophy.Methods:Retrospective chart review of 108 patients with SDB who underwent general anesthesia for adenotonsillectomy (TA) or adenoidectomy with concomitant DL. The following data were collected: demographic information, medical comorbidities, polysomnography results, anesthetic techniques, and postoperative complications.Results:94.5% of children had DL findings consistent with LM, including a retropositioned epiglottis and short aryepiglottic folds. Postglottic edema was observed in 42.2%, and these patients were significantly more likely to have a diagnosis of gastroesophageal reflux (P =0.023). 57.8% had vocal cord edema. 75.3% of children who received routine postoperative follow-up care experienced complete symptom resolution. Postoperative complications following discharge from hospital occurred in 12.4% of patients, and 15.7% underwent supraglottoplasty for continued SDB symptoms after TA or adenoidectomy.Conclusion:A substantial proportion of patients with SDB who lacked tonsillar hypertrophy had findings consistent with LM, suggesting that the larynx may be the primary site of upper airway obstruction in these patients. This has significant implications in terms of perioperative management. The majority of patients with SDB had symptomatic improvement following TA or adenoidectomy; however, a subset required further surgical intervention with supraglottoplasty.
机译：背景：儿科麻醉师经常面对患有睡眠呼吸障碍（SDB）的儿童，要求进行扁桃体切除术和/或麻醉。典型患者有扁桃体阻塞的阻塞性睡眠呼吸暂停（OSA）症状;但是，部分患者可能患有潜在的喉头软化症（LM）而无扁桃体肥大。 OSA和LM均显着增加术中和术后气道阻塞的风险以及对麻醉品的敏感性。 LM的患病率可能被低估了，因为在缺乏扁桃体肥大的SDB患者的诊断评估中并未常规进行直接喉镜检查（DL）。目的：确定没有扁桃体肥大的SDB儿科患者的患病率和DL结果。回顾性图表回顾性分析了108例接受全麻腺腺扁桃体切除术（TA）或腺样体切除术并发DL的SDB患者。收集以下数据：人口统计学信息，医疗合并症，多导睡眠图检查结果，麻醉技术和术后并发症。结果：94.5％的儿童有与LM一致的DL表现，包括重新会厌和会厌短。观察到声门后水肿的比例为42.2％，这些患者被诊断出胃食管反流的可能性明显更高（P = 0.023）。 57.8％发生声带水肿。 75.3％接受常规术后随访护理的儿童症状完全缓解。出院后发生手术后并发症的患者为12.4％，对于接受TA或腺样体切除术后继续出现SDB症状的患者，需进行声门上成形术。结论：相当一部分缺乏扁桃体肥大的SDB患者的发现与LM一致，提示喉这些患者可能是上呼吸道阻塞的主要部位。这对围手术期管理具有重要意义。大多数SDB患者在TA或腺样体切除术后症状有所改善。然而，有一部分需要进一步的手术治疗。

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