Surgical Treatment Of Severe OSAHS Complicated With Cardiac Dysfunction In Preschool Children

Objective:To analyze the changes in cardiac structure and related indicators of children with severe sleep apnea hypopnea syndrome(OSAHS)before and after surgical treatment in children with severe sleep apnea hypopnea syndrome(OSAHS)aged 4-5 years through data.Changes in cardiovascular structure and function in children with severe OSAHS.Provide reference for clinical diagnosis and treatment Second:By comparing the cardiac structure,serum myocardium,and other indicators of patients with tonsil with adenoidectomy before and 1 month and 6 months after surgery,the changes in polysomnographic monitoring results before and 6 months after surgery,It is further proved whether the tonsil with adenoidectomy can effectively reverse the changes in cardiac structure and function caused by OSAHS.Third:By summarizing the perioperative management measures for children with severe OSAHS and cardiac dysfunction,the risk of surgery in such children is reduced and the efficiency of surgery is improved.Methods:A retrospective analysis of 3280 children who were admitted to the Children's Hospital of Kunming Medical University from January 2017 to January 2020 due to sleep snoring with open mouth breathing.Through their medical history,routine examination,and electronic nasopharyngology He was diagnosed with tonsil hypertrophy and adenoidal hypertrophy,and was diagnosed with severe OSAHS by polysomnogruphy(PSG).Preoperative cardiac color Doppler ultrasound examination showed abnormal cardiac function.At the same time,he was ruled out with no history of congenital heart disease.Twenty-one children aged 4-5 years(<5)were used as the experimental group.At the same time,a physical examination at the Children's Hospital of Kunming Medical University was selected.No abnormal sleep such as sleep snoring or mouth breathing,and physical examination to exclude tonsils with adenoids.Twenty-one healthy children of 4-5 years old with body hypertrophy and no other related diseases were used as the control group;the effects of severe OSAHS on the cardiac structure and functional parameters of patients were analyzed.At the same time,children with severe OSAHS who underwent adenoid and tonsillectomy were followed up.Regularly review his 1-and 6-month postoperative polysomnography,cardiac color Doppler(TDI),and serum myocardial indicators.Compare Sao2,AHI,cardiac structural indicators,and serum in patients before and after surgery.Changes in myocardial indicators.Results:Basic information:This experiment included 21 cases of severe OSAHS children aged 4-5 years as the experimental group,including 15 males and 6 females.There were 19 cases of Han nationality and 2 cases of ethnic minorities.There were 21 cases in the control group,including 14 males,7 females,16 Hans,and 5 ethnic minorities.? By c2 test,there was no statistically significant difference in ethnicity,gender,and residence permit between the test group and the control group(P>0.05).After two independent sample t tests:there was no statistically significant difference in age between the test group and the control group(P=0.370).?Compared with the control group,in the severe OSAHS group,the right atrium diameter(Right),right ventricle diameter(RV),ventricular septal thickness(IVS),and right ventricular septal thickness(Right)ventricular anterior wall thickness(RVAW),pulmonary artery diameter(Pulmonary artery diameter,PA),and aortic diameter(Inner diameter of aorta,OA)were significantly higher than the control group,the difference was statistically significant(P<0.01).Left atrium diameter(LA),left ventricle diameter(LV),and posterior wall inner diameter(LVPW)were not significantly different from those of the control group(P<0.05).In addition,E/A(late mitral valve diastolic blood flow velocity A,early mitral valve diastolic blood flow velocity E),left ventricular ejection fraction(EF),short axis shortening rate(Short axis shortening rate,FS)is significantly shortened.? Compared with the changes of AHI and SaO2 indexes before and 6 months after operation in children with severe OSAHS complicated with cardiac dysfunction,it was found that their values changed significantly before and after surgery,and they were close to normal levels at 6 months after surgery,reaching the standard of cure.?Compared with children with severe OSAHS complicated with cardiac dysfunction before and 1 month and 6 months after operation,the cardiac structure and cardiac function changes.The results showed that the RA,RV,RA,RV of 1 month and 6 months after operation,IVS,RVAW,PA,OA were significantly lower than before surgery,the difference was statistically significant(P<0.01).EF,FS,and E/A were significantly shorter than before surgery,while LA,LV,and LVPW had no significant changes.? Compared with the preoperative period,the cardiac enzymes Cardiac troponin(CTnl),Creatine kinase isoenzyme(CK-MB)and myoglobin(Myoglobin,Mb)of the patients were all reduced.After January close to normal levels.Conclusions:1.There is no significant difference in ethnicity,gender,and residence in severe OSAHS.2.Severe OSAHS in children can cause structural and functional changes of the heart,mainly the structural changes of the right heart,and the left heart function is affected to a certain extent.3.For children with severe OSAHS caused by tonsil and adenoid hypertrophy,surgery can not only significantly improve the patient's hypoxia and apnea.It can also effectively reverse changes in cardiac structure and function.4.For patients with severe OSAHS combined with cardiac dysfunction,it is necessary to summarize the management methods during the perioperative period,which can reduce the risk of surgery and improve the efficacy of surgery.