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Pediatrics：AAP发新版阻塞性睡眠呼吸暂停治疗指南

2012-09-03 不详 网络

阻塞性睡眠呼吸暂停治疗指南增殖腺扁桃体切除术
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《儿科学》(Pediatrics)8月27日发表的美国儿科学会(AAP)新版临床治疗指南建议，行增殖腺扁桃体切除术的阻塞性睡眠呼吸暂停综合征(OSAS)患儿应住院(Pediatrics 2012;130:576-84)。 Carole L. Marcus博士 新版指南是由AAP的OSAS委员会对1999~2008年发表的3166篇相关论文及2008~2011年发表的指南类文章进行综述后制订的。

《儿科学》(Pediatrics)8月27日发表的美国儿科学会(AAP)新版临床治疗指南建议，行增殖腺扁桃体切除术的阻塞性睡眠呼吸暂停综合征(OSAS)患儿应住院(Pediatrics 2012;130:576-84)。


Carole L. Marcus博士

新版指南是由AAP的OSAS委员会对1999~2008年发表的3166篇相关论文及2008~2011年发表的指南类文章进行综述后制订的。


新版指南的部分重要建议如下：

·对于轻度OSAS儿童患者，特别是不适合接受手术或已接受手术且残留阻塞性呼吸暂停的患者，鼻内激素给药可有助于缓解症状。

·建议临床医生可常规进行OSAS筛查。可向儿童父母询问几个问题。一是：孩子睡眠如何？二是：有打鼾现象吗？如有，则继续询问打鼾时是否伴有呼吸困难。根据经验和病史，可对儿童进行睡眠检查等进一步客观评估。

·建议以下患儿在扁桃体切除术后住院：3岁以下；多导睡眠图检查提示重度OSAS；OSAS心脏并发症；发育停滞；肥胖；颅面畸形、神经肌肉疾病或当前呼吸道感染。

·如果扁桃体切除术后OSAS体征和症状持续存在，或如果未进行扁桃体切除术，则建议进行持续气道正压通气(CPAP)治疗。小组专家表示，CPAP是最佳的二线治疗方案。

·如果儿童或青少年经常打鼾或符合OSAS症状和体征，则建议进行多导睡眠图检查或转至睡眠专科或耳鼻喉科治疗。不过该建议未获得委员会专家和咨询医学学会的一致认可，因为现有的医疗资源无法对每例患儿都开展此项检查。而且研究显示，在50%的情况下，即使病史提示OSAS，睡眠检查结果仍可能为正常。因此，一个折中的建议是，如果无法进行多导睡眠图检查，可考虑进行其他诊断性检查，如夜间视频录制、夜间血氧饱和度测定、午睡多导睡眠图检查或门诊多导睡眠图检查。

小组专家声明与Philips Respironics等多家公司存在利益关系。

链接：
Marcus CL, Brooks LJ, Ward SD, Draper KA, Gozal D, Halbower AC, Jones J, Lehmann C, Schechter MS, Sheldon S, Shiffman RN, Spruyt K.Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome.Pediatrics.2012 Aug 27

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    2012-09-11 ms9608593228839890

    #DIA#

    0

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    2013-01-02 w984445tii

    #治疗指南#

    0

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    2012-12-04 zhanfl

    #睡眠呼吸#

    0

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    2013-02-28 feather89

    #PE#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1636562, encodeId=76c8163656230, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Tue Sep 11 19:53:00 CST 2012, time=2012-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1934731, encodeId=d7e21934e315c, content=<a href='/topic/show?id=1072646328c' target=_blank style='color:#2F92EE;'>#治疗指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64632, encryptionId=1072646328c, topicName=治疗指南)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6732482, createdName=w984445tii, createdTime=Wed Jan 02 00:53:00 CST 2013, time=2013-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1988951, encodeId=79db1988951f9, content=<a href='/topic/show?id=246ee29858f' target=_blank style='color:#2F92EE;'>#睡眠呼吸#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72985, encryptionId=246ee29858f, topicName=睡眠呼吸)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3138208, createdName=zhanfl, createdTime=Tue Dec 04 23:53:00 CST 2012, time=2012-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1725449, encodeId=58e31e2544993, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Thu Feb 28 00:53:00 CST 2013, time=2013-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1958365, encodeId=cd9c19583656f, content=<a href='/topic/show?id=766713993a1' target=_blank style='color:#2F92EE;'>#Pediatric#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13993, encryptionId=766713993a1, topicName=Pediatric)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Thu Nov 15 14:53:00 CST 2012, time=2012-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1696612, encodeId=69a3169661263, content=<a href='/topic/show?id=d2e99e651e4' target=_blank style='color:#2F92EE;'>#阻塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97651, encryptionId=d2e99e651e4, topicName=阻塞)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a23129903429, createdName=tomyang96, createdTime=Sun Jul 07 09:53:00 CST 2013, time=2013-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1633182, encodeId=5b2c16331820d, content=<a href='/topic/show?id=c0bf168341' target=_blank style='color:#2F92EE;'>#AAP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1683, encryptionId=c0bf168341, topicName=AAP)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=89e022034329, createdName=ylz8410, createdTime=Tue Sep 18 21:53:00 CST 2012, time=2012-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1596416, encodeId=6a3515964168e, content=<a href='/topic/show?id=70e4396491a' target=_blank style='color:#2F92EE;'>#呼吸暂停#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39649, encryptionId=70e4396491a, topicName=呼吸暂停)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e2a518392360, createdName=119337463, createdTime=Wed Sep 05 01:53:00 CST 2012, time=2012-09-05, status=1, ipAttribution=)]
    2012-11-15 hbwxf

    #Pediatric#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1636562, encodeId=76c8163656230, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Tue Sep 11 19:53:00 CST 2012, time=2012-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1934731, encodeId=d7e21934e315c, content=<a href='/topic/show?id=1072646328c' target=_blank style='color:#2F92EE;'>#治疗指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64632, encryptionId=1072646328c, topicName=治疗指南)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6732482, createdName=w984445tii, createdTime=Wed Jan 02 00:53:00 CST 2013, time=2013-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1988951, encodeId=79db1988951f9, content=<a href='/topic/show?id=246ee29858f' target=_blank style='color:#2F92EE;'>#睡眠呼吸#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72985, encryptionId=246ee29858f, topicName=睡眠呼吸)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3138208, createdName=zhanfl, createdTime=Tue Dec 04 23:53:00 CST 2012, time=2012-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1725449, encodeId=58e31e2544993, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Thu Feb 28 00:53:00 CST 2013, time=2013-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1958365, encodeId=cd9c19583656f, content=<a href='/topic/show?id=766713993a1' target=_blank style='color:#2F92EE;'>#Pediatric#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13993, encryptionId=766713993a1, topicName=Pediatric)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Thu Nov 15 14:53:00 CST 2012, time=2012-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1696612, encodeId=69a3169661263, content=<a href='/topic/show?id=d2e99e651e4' target=_blank style='color:#2F92EE;'>#阻塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97651, encryptionId=d2e99e651e4, topicName=阻塞)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a23129903429, createdName=tomyang96, createdTime=Sun Jul 07 09:53:00 CST 2013, time=2013-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1633182, encodeId=5b2c16331820d, content=<a href='/topic/show?id=c0bf168341' target=_blank style='color:#2F92EE;'>#AAP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1683, encryptionId=c0bf168341, topicName=AAP)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=89e022034329, createdName=ylz8410, createdTime=Tue Sep 18 21:53:00 CST 2012, time=2012-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1596416, encodeId=6a3515964168e, content=<a href='/topic/show?id=70e4396491a' target=_blank style='color:#2F92EE;'>#呼吸暂停#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39649, encryptionId=70e4396491a, topicName=呼吸暂停)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e2a518392360, createdName=119337463, createdTime=Wed Sep 05 01:53:00 CST 2012, time=2012-09-05, status=1, ipAttribution=)]
    2013-07-07 tomyang96

    #阻塞#

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1636562, encodeId=76c8163656230, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Tue Sep 11 19:53:00 CST 2012, time=2012-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1934731, encodeId=d7e21934e315c, content=<a href='/topic/show?id=1072646328c' target=_blank style='color:#2F92EE;'>#治疗指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64632, encryptionId=1072646328c, topicName=治疗指南)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6732482, createdName=w984445tii, createdTime=Wed Jan 02 00:53:00 CST 2013, time=2013-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1988951, encodeId=79db1988951f9, content=<a href='/topic/show?id=246ee29858f' target=_blank style='color:#2F92EE;'>#睡眠呼吸#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72985, encryptionId=246ee29858f, topicName=睡眠呼吸)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3138208, createdName=zhanfl, createdTime=Tue Dec 04 23:53:00 CST 2012, time=2012-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1725449, encodeId=58e31e2544993, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Thu Feb 28 00:53:00 CST 2013, time=2013-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1958365, encodeId=cd9c19583656f, content=<a href='/topic/show?id=766713993a1' target=_blank style='color:#2F92EE;'>#Pediatric#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13993, encryptionId=766713993a1, topicName=Pediatric)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Thu Nov 15 14:53:00 CST 2012, time=2012-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1696612, encodeId=69a3169661263, content=<a href='/topic/show?id=d2e99e651e4' target=_blank style='color:#2F92EE;'>#阻塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97651, encryptionId=d2e99e651e4, topicName=阻塞)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a23129903429, createdName=tomyang96, createdTime=Sun Jul 07 09:53:00 CST 2013, time=2013-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1633182, encodeId=5b2c16331820d, content=<a href='/topic/show?id=c0bf168341' target=_blank style='color:#2F92EE;'>#AAP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1683, encryptionId=c0bf168341, topicName=AAP)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=89e022034329, createdName=ylz8410, createdTime=Tue Sep 18 21:53:00 CST 2012, time=2012-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1596416, encodeId=6a3515964168e, content=<a href='/topic/show?id=70e4396491a' target=_blank style='color:#2F92EE;'>#呼吸暂停#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39649, encryptionId=70e4396491a, topicName=呼吸暂停)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e2a518392360, createdName=119337463, createdTime=Wed Sep 05 01:53:00 CST 2012, time=2012-09-05, status=1, ipAttribution=)]
    2012-09-18 ylz8410

    #AAP#

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1636562, encodeId=76c8163656230, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Tue Sep 11 19:53:00 CST 2012, time=2012-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1934731, encodeId=d7e21934e315c, content=<a href='/topic/show?id=1072646328c' target=_blank style='color:#2F92EE;'>#治疗指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64632, encryptionId=1072646328c, topicName=治疗指南)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6732482, createdName=w984445tii, createdTime=Wed Jan 02 00:53:00 CST 2013, time=2013-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1988951, encodeId=79db1988951f9, content=<a href='/topic/show?id=246ee29858f' target=_blank style='color:#2F92EE;'>#睡眠呼吸#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72985, encryptionId=246ee29858f, topicName=睡眠呼吸)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3138208, createdName=zhanfl, createdTime=Tue Dec 04 23:53:00 CST 2012, time=2012-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1725449, encodeId=58e31e2544993, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Thu Feb 28 00:53:00 CST 2013, time=2013-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1958365, encodeId=cd9c19583656f, content=<a href='/topic/show?id=766713993a1' target=_blank style='color:#2F92EE;'>#Pediatric#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13993, encryptionId=766713993a1, topicName=Pediatric)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Thu Nov 15 14:53:00 CST 2012, time=2012-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1696612, encodeId=69a3169661263, content=<a href='/topic/show?id=d2e99e651e4' target=_blank style='color:#2F92EE;'>#阻塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97651, encryptionId=d2e99e651e4, topicName=阻塞)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a23129903429, createdName=tomyang96, createdTime=Sun Jul 07 09:53:00 CST 2013, time=2013-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1633182, encodeId=5b2c16331820d, content=<a href='/topic/show?id=c0bf168341' target=_blank style='color:#2F92EE;'>#AAP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1683, encryptionId=c0bf168341, topicName=AAP)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=89e022034329, createdName=ylz8410, createdTime=Tue Sep 18 21:53:00 CST 2012, time=2012-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1596416, encodeId=6a3515964168e, content=<a href='/topic/show?id=70e4396491a' target=_blank style='color:#2F92EE;'>#呼吸暂停#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39649, encryptionId=70e4396491a, topicName=呼吸暂停)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e2a518392360, createdName=119337463, createdTime=Wed Sep 05 01:53:00 CST 2012, time=2012-09-05, status=1, ipAttribution=)]
    2012-09-05 119337463

    #呼吸暂停#

    0