纳美芬对开胸手术患者术后呼吸抑制的拮抗作用

Antagonistic effect of nalmefene on postoperative respiratory depression in patients after thoracic surgery

目的观察纳美芬拮抗开胸手术患者术后呼吸抑制的效果。方法 72例开胸手术患者,均采用静吸复合全麻,根据术后拮抗药物的不同分为3组,每组24例:A组(对照组)、B组(纳洛酮组)和C组(纳美芬组)。B组在手术结束后5 min静脉推注纳洛酮1μg/kg,C组在手术结束后5 min静脉推注纳美芬0.25μg/kg,A组则不作任何处理。观察患者使用阿片受体拮抗药前、用药后不同时间点生命体征的变化、用药后10 min呼吸恢复率、拔管时间、拔管后5 min意识状况评分、拔管后30 min镇痛评分以及各种不良反应。结果三组间患者使用阿片受体拮抗药前后不同时间点生命体征的变化差异无统计学意义(P>0.05)。B、C组用药后10 min呼吸恢复率高于A组(P<0.05),拔管时间短于A组(P<0.05),B、C组间比较差异无统计学意义(P>0.05)。三组患者意识状况评分、镇痛评分及不良反应发生率差异均无统计学意义(P>0.05)。结论纳美芬可以安全、有效地拮抗开胸手术患者术后的呼吸抑制作用,其效果与纳洛酮类似。

Objective To explore the effect of nalmefene on the postoperative respiratory depression in patients after the thoracic surgery.Methods Seventy-two patients undergoing thoracic surgery were divided into 3 groups according to the drugs after surgery.The patients in naloxon group and nalmefene group were injected intravenously with naloxone（1 μg/kg） and nalmefene（0.25 μg/kg） 5 min after operation,respectively,while patients were not given drugs in control group.Blood pressure（BP）,heart rate（HR）,pulse oxygen saturation（SpO2） before and after administration,respiratory recovery rate in 10 min after administration,extubation time,Ramsay sedation score at 5 min after extubation,visual analogue score（VAS） at 30 min after extubation and adverse effects were observed.Results No significant difference was detected in BP,HR,SpO2 before and after administration among three groups（P〉0.05）.Respiratory recovery rates in 10 min after administration in naloxon group and nalmefene group were higher than that in control group（P〈0.05）,and extubation time in naloxon group and nalmefene group was shorter than that in control group（P〈0.05）,but there was no significant difference between naloxon group and nalmefene group（P〉0.05）.No significant difference was detected in Ramsay sedation score,visual analogue score and incidence of adverse effects among three groups（P〉0.05）.Conclusion Nalmefene is effective and safe for antagonizing the postoperative respiratory depression in thoracic surgery patients.The efficacy is equal to naloxone.