目的:阻塞型睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)患者围手术期并发症发生率高,可能与OSAS患者对阿片类药物的敏感性增加有关。然而,OSAS患者对阿片类药物的敏感性是否增加,目前尚有争议。本研究探讨男性中重度O...目的:阻塞型睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)患者围手术期并发症发生率高,可能与OSAS患者对阿片类药物的敏感性增加有关。然而,OSAS患者对阿片类药物的敏感性是否增加,目前尚有争议。本研究探讨男性中重度OSAS患者对阿片类药物瑞芬太尼的敏感性是否增加及其预测因素,旨在为OSAS患者合理使用阿片类药物提供参考。方法:本研究是前瞻性研究。选取2021年12月28日至2022年10月15日在全身麻醉下行鼻咽部手术的男性患者61例,年龄22~60岁,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ-Ⅱ级,根据OSAS初筛问卷STOP-BANG量表评分和呼吸暂停低通气指数(apnea-hypopnea index,AHI)分为OSAS组(n=39)和对照组(n=22)。采用手持式单目瞳孔测量仪测量2组患者的瞳孔直径(pupil diameter,PD),体感诱发电位刺激仪测量2组患者的感觉阈值(perception threshold,PT)和耐痛阈值(pain tolerance threshold,PTT)。在安静的环境下,测量患者初始PD、PT、PTT,并记为PD0、PT0、PTT0。在输注瑞芬太尼后,记录PD、PT、PTT、呼吸和意识的变化情况。将年龄、体重指数(body mass index,BMI)、吸烟、AHI、睡眠期间最低血氧饱和度、血氧饱和度<90%的时间占总监测时间的百分比(percentage of sleep time spent with oxygen saturation<90%,T90)作为自变量纳入多元线性回归方程,分析中重度OSAS患者对瑞芬太尼敏感性增加的预测因素。结果:OSAS组与对照组之间PD0、PT0和PTT0的差异均无统计学意义(均P>0.05);在输注瑞芬太尼后,2组间PT变化率差异无统计学意义(P>0.05),OSAS组PTT和PD的变化率明显大于对照组(分别为P<0.05和P<0.001),PD显著小于对照组(P<0.001);在瑞芬太尼输注过程中,2组的呼吸抑制发生率、警觉/镇静评分分布差异均无统计学意义(均P>0.05),2组患者均无精神状态改变和气道支持。多元线性回归结果显示:T90与PD变化率(β=0.597,95%CI 0.269~0.924)和PTT变化率(β=0.458,95%CI 0.116~0.800)均呈正相关(均P<0.05),但睡眠期间最低血氧饱和度、年龄、BMI、吸烟、AHI与PD变化率和PTT变化率均无相关性(均P>0.05)。结论:成年男性中重度OSAS患者对瑞芬太尼的敏感性增加,夜间缺氧持续时间可能是其预测因素。夜间缺氧持续时间越长的男性中重度OSAS患者对瑞芬太尼越敏感,在临床上对该类患者使用阿片类药物需要更加谨慎。展开更多
BACKGROUND: The Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure trial tested the hypothesis that continuous positive airway pressure(CPAP) would improve the surviva...BACKGROUND: The Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure trial tested the hypothesis that continuous positive airway pressure(CPAP) would improve the survival rate without heart transplantation of patients who have central sleep apnea and heart failure. METHODS: After medical therapy was optimized, 258 patients who had heart failure(mean age [± SD], 63± 10 years; ejection fraction, 24.5± 7.7 percent) and central sleep apnea(number of episodes of apnea and hypopnea per hour of sleep, 40± 16) were randomly assigned to receive CPAP(128 patients) or no CPAP(130 patients) and were followed for a mean of two years. During follow- up, sleep studies were conducted and measurements of the ejection fraction, exercise capacity, quality of life, and neurohormones were obtained. RESULTS: Three months after undergoing randomization, the CPAP group, as compared with the control group, had greater reductions in the frequency of episodes of apnea and hypopnea(- 21± 16 vs.- 2± 18 per hour, P< 0.001) and in norepinephrine levels(- 1.03± 1.84 vs. 0.02± 0.99 nmol per liter, P=0.009), and greater increases in the mean nocturnal oxygen saturation(1.6± 2.8 percent vs. 0.4± 2.5 percent, P< 0.001), ejection fraction(2.2± 5.4 percent vs. 0.4± 5.3 percent, P=0.02), and the distance walked in six minutes(20.0± 55 vs.- 0.8± 64.8 m, P=0.016). There were no differences between the control group and the CPAP group in the number of hospitalizations, quality of life, or atrial natriuretic peptide levels. An early divergence in survival rates without heart transplantation favored the control group, but after 18 months the divergence favored the CPAP group, yet the overall event rates(death and heart transplantation) did not differ(32 vs. 32 events, respectively; P=0.54). CONCLUSIONS: Although CPAP attenuated central sleep apnea, improved nocturnal oxygenation, increased the ejection fraction, lowered norepinephrine levels, and increased the distance walked in six minutes, it did not affect survival. Our data do not support the use of CPAP to extend life in patients who have central sleep apnea and heart failure.展开更多
文摘目的:阻塞型睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)患者围手术期并发症发生率高,可能与OSAS患者对阿片类药物的敏感性增加有关。然而,OSAS患者对阿片类药物的敏感性是否增加,目前尚有争议。本研究探讨男性中重度OSAS患者对阿片类药物瑞芬太尼的敏感性是否增加及其预测因素,旨在为OSAS患者合理使用阿片类药物提供参考。方法:本研究是前瞻性研究。选取2021年12月28日至2022年10月15日在全身麻醉下行鼻咽部手术的男性患者61例,年龄22~60岁,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ-Ⅱ级,根据OSAS初筛问卷STOP-BANG量表评分和呼吸暂停低通气指数(apnea-hypopnea index,AHI)分为OSAS组(n=39)和对照组(n=22)。采用手持式单目瞳孔测量仪测量2组患者的瞳孔直径(pupil diameter,PD),体感诱发电位刺激仪测量2组患者的感觉阈值(perception threshold,PT)和耐痛阈值(pain tolerance threshold,PTT)。在安静的环境下,测量患者初始PD、PT、PTT,并记为PD0、PT0、PTT0。在输注瑞芬太尼后,记录PD、PT、PTT、呼吸和意识的变化情况。将年龄、体重指数(body mass index,BMI)、吸烟、AHI、睡眠期间最低血氧饱和度、血氧饱和度<90%的时间占总监测时间的百分比(percentage of sleep time spent with oxygen saturation<90%,T90)作为自变量纳入多元线性回归方程,分析中重度OSAS患者对瑞芬太尼敏感性增加的预测因素。结果:OSAS组与对照组之间PD0、PT0和PTT0的差异均无统计学意义(均P>0.05);在输注瑞芬太尼后,2组间PT变化率差异无统计学意义(P>0.05),OSAS组PTT和PD的变化率明显大于对照组(分别为P<0.05和P<0.001),PD显著小于对照组(P<0.001);在瑞芬太尼输注过程中,2组的呼吸抑制发生率、警觉/镇静评分分布差异均无统计学意义(均P>0.05),2组患者均无精神状态改变和气道支持。多元线性回归结果显示:T90与PD变化率(β=0.597,95%CI 0.269~0.924)和PTT变化率(β=0.458,95%CI 0.116~0.800)均呈正相关(均P<0.05),但睡眠期间最低血氧饱和度、年龄、BMI、吸烟、AHI与PD变化率和PTT变化率均无相关性(均P>0.05)。结论:成年男性中重度OSAS患者对瑞芬太尼的敏感性增加,夜间缺氧持续时间可能是其预测因素。夜间缺氧持续时间越长的男性中重度OSAS患者对瑞芬太尼越敏感,在临床上对该类患者使用阿片类药物需要更加谨慎。
文摘BACKGROUND: The Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure trial tested the hypothesis that continuous positive airway pressure(CPAP) would improve the survival rate without heart transplantation of patients who have central sleep apnea and heart failure. METHODS: After medical therapy was optimized, 258 patients who had heart failure(mean age [± SD], 63± 10 years; ejection fraction, 24.5± 7.7 percent) and central sleep apnea(number of episodes of apnea and hypopnea per hour of sleep, 40± 16) were randomly assigned to receive CPAP(128 patients) or no CPAP(130 patients) and were followed for a mean of two years. During follow- up, sleep studies were conducted and measurements of the ejection fraction, exercise capacity, quality of life, and neurohormones were obtained. RESULTS: Three months after undergoing randomization, the CPAP group, as compared with the control group, had greater reductions in the frequency of episodes of apnea and hypopnea(- 21± 16 vs.- 2± 18 per hour, P< 0.001) and in norepinephrine levels(- 1.03± 1.84 vs. 0.02± 0.99 nmol per liter, P=0.009), and greater increases in the mean nocturnal oxygen saturation(1.6± 2.8 percent vs. 0.4± 2.5 percent, P< 0.001), ejection fraction(2.2± 5.4 percent vs. 0.4± 5.3 percent, P=0.02), and the distance walked in six minutes(20.0± 55 vs.- 0.8± 64.8 m, P=0.016). There were no differences between the control group and the CPAP group in the number of hospitalizations, quality of life, or atrial natriuretic peptide levels. An early divergence in survival rates without heart transplantation favored the control group, but after 18 months the divergence favored the CPAP group, yet the overall event rates(death and heart transplantation) did not differ(32 vs. 32 events, respectively; P=0.54). CONCLUSIONS: Although CPAP attenuated central sleep apnea, improved nocturnal oxygenation, increased the ejection fraction, lowered norepinephrine levels, and increased the distance walked in six minutes, it did not affect survival. Our data do not support the use of CPAP to extend life in patients who have central sleep apnea and heart failure.
