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

Clinical observation of nalmefene combined with sufentanil in uvulopalatopharyngoplasty in recovery period

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0.1μg·kg-1的同时给予盐酸纳美芬0.25μg·kg-1,5 min后可重复给纳美芬,直至呼吸频率>10次·min-1、PETCO2<45 mm Hg、呼吸暂停<15 s停止给药,累计给药量<1μg·kg-1。C组在手术结束时给予舒芬太尼0.1μg·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^-1and nalmefene 0. 25 μg·kg^-1at the end of surgery,and an additional 0. 25 μg·kg^-1 of nalmefene 5 min later until their respiratory rate was up to10 times per minute,PETCO2 45 mm Hg,apnea 15 s. The cumulative dose of nalmefene was limited toless than1 μg·kg^-1. Group C was given sufentanil 0. 1 μg · kg^-1at 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.