纳美芬联合舒芬太尼用于悬雍垂腭咽成形术苏醒期的临床观察-东南大学学报医学版

纳美芬联合舒芬太尼用于悬雍垂腭咽成形术苏醒期的临床观察

单位：东南大学附属中大医院麻醉科, 江苏南京 210009

分类号：R971.2

出版年·卷·期（页码）：2016·35·第五期（751-754）

摘要：

目的：观察纳美芬联合舒芬太尼用于悬雍垂腭咽成形术（UPPP）苏醒期对阻塞性睡眠呼吸暂停综合征（OSAS）患者的复苏质量和安全性的影响。方法：选取须在全麻下行UPPP的OSAS患者98例，按随机数字表法分为对照组（C组）和纳美芬组（N组），每组49例。N组在手术结束时给予舒芬太尼0.1 μg·kg^-1的同时给予盐酸纳美芬0.25 μg·kg^-1，5 min后可重复给纳美芬，直至呼吸频率>10 次·min^-1、P_ETCO₂<45 mmHg、呼吸暂停<15 s停止给药，累计给药量<1 μg·kg^-1。C组在手术结束时给予舒芬太尼0.1 μg·kg^-1。比较两组术前、拔管即刻、拔管后5 min时的循环指标（HR、MAP）、呼吸恢复时间、气管拔管时间、拔管后5 min的意识状态评分（Ramsay评分）和视觉模拟评分（VAS）及苏醒期的不良反应发生率。结果：两组苏醒期MAP、HR和VAS差异均无统计学意义（P>0.05）；N组呼吸恢复时间和拔管时间明显短于C组（P<0.05），拔管后Ramsay评分明显低于C组（P<0.05），苏醒期呼吸抑制和恶心呕吐发生率明显低于C组（P<0.05）。结论：苏醒期应用小剂量纳美芬和舒芬太尼明显加快OSAS患者UPPP后的恢复速度，减少呼吸抑制和恶心呕吐等不良反应，有利于提高术后复苏质量和安全性。

Objective:To observe the effects of nalmefene combined with sufentanil on patient with obstructive sleep apnea syndrome (OSAS) undergoing uvulopalatopharyngoplasty(UPPP)during recovery period after surgery. Methods:Ninety eight patients scheduled to receive UPPP were randomly divided into control group (group C, n=49) and nalmefene group (group N, n=49). Group N received sufentanil 0.1 μg·kg^-1 and nalmefene 0.25 μg·kg^-1 at the end of surgery, and an additional 0.25 μg·kg^-1 of nalmefene 5 min later until their respiratory rate was up to 10 times per minute, P_ETCO₂<45 mmHg, apnea<15 s. The cumulative dose of nalmefene was limited toless than 1 μg·kg^-1. Group C was given sufentanil 0.1 μg·kg^-1 at the end of the operation. Results:The respiratory recovery time and extubation time of group N were significantly shorter than that of group C (P<0.05). The Ramsay score of N group was significantly lower than that of C group (P<0.05). Respiratory depression and nausea and vomiting were significantly less than those of group C in recovery period(P<0.05). Conclusion: Nalmefene combined with sufentanil significantly reduced adverse reactions in obstructive sleep apnea syndrome patients during their recovery period, which is beneficial to recovery from anesthesia.

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