阿片类药物致阻塞性睡眠呼吸暂停患者围手术期呼吸抑制风险及应对措施  

Respiratory depression risk and its counter measures in patients with obstructive sleep apnea caused by opioids

作　　者：刘海琴[1] 闫妍 杨敏娟[1] 冯雅妮 李伟[2] 任晓勇[1] LIU Hai-qin;YAN Yan;YANG Min-juan;FENG Ya-ni;LI Wei;REN Xiao-yong(Department of Otolaryngology Head and Neck Surgery,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,Shannxi Province,China;Department of Anesthesiology,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,Shannxi Province,China)

机构地区：[1]西安交通大学第二附属医院耳鼻咽喉头颈外科,陕西西安710004 [2]西安交通大学第二附属医院麻醉科,陕西西安710004

出　　处：《世界临床药物》2019年第10期732-736,共5页World Clinical Drug

基　　金：陕西省重点研发计划(2019SF-084)

摘　　要：目的分析探讨阿片类药物使用与阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)患者围手术期严重呼吸抑制事件的相关性,提高临床防治水平。方法回顾分析2016年1月至2018年12月本院收治的8例发生围手术期严重呼吸抑制的OSA病例的临床资料,并与同期20例患病及治疗情况类似但未发生上述危象的病例比较,分析病情严重程度、麻醉药物应用、术后拔管时间、术后苏醒室观察时长及术后镇痛药物应用等与上述事件的关系。结果围手术期呼吸抑制组和对照组相比年龄、体质量指数(body mass index,BMI)差异无统计学意义(P>0.05)。与对照组相比,呼吸抑制组阿片类药物使用率高、术后至拔除气管插管时间更短、术后麻醉苏醒室观察总时间更短,差异具有统计学意义(P<0.05)。结论OSA疾病存在呼吸中枢等多脏器潜在损害,阿片类药物应用可能增加患者围手术期呼吸抑制风险;适当延长术后拔管时间和麻醉苏醒室观察时间,尽量避免在围手术期使用阿片类药物镇痛,有助于减少运转途中或病房中突发呼吸抑制意外的发生。Objective To analyze and discuss the correlation between the use of opioids and severe respiratory depression events in obstructive sleep apnea(OSA)patients during perioperative period,so as to improve the level of clinical prevention and treatment.Methods We retrospectively analyzed the clinical data of 8 cases of OSA with perioperative severe respiratory depression admitted to our hospital from January 2016 to December 2018,and compared with 20 cases with similar illness and treatment but no such crisis happened,to explore the relationship of severity of the disease,the application of anesthetic drugs,the time of extubation,the length of observation after surgery,and the application of postoperative analgesic drugs to crisis.Results There was no significant difference in age and body mass index between the perioperative respiratory depression group and the control group(P>0.05).Compared with the control group,the respiratory depression group had higher opioid use rate,shorter time from the postoperative to the tracheal intubation,and the total time of the postoperative anesthesia recovery room in the respiratory depression group was shorter than control group.The difference was statistically significant(P<0.05).Conclusion OSA disease has potential damage to multiple organs such as respiratory center.Opoids and other drug applications lead to greater risk of perioperative respiratory depression.During anesthesia,the use of long-term respiratory inhibition drugs should be minimized,the recovery of anesthesia should be sufficient,enough observation time and postoperative analgesia should be avoided the use of drugs with respiratory center inhibition,all those can effectively reduce the occurrence of sudden respiratory inhibition accidents during operation or in the ward.

关 键 词：阻塞性睡眠呼吸暂停 阿片类药物 围手术期 呼吸抑制 

分 类 号：R766.43[医药卫生—耳鼻咽喉科]