摘要
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
Objective:Obstructive sleep apnea syndrome(OSAS)is associated with increased risk of postoperative complications,which is possibly related to increased sensitivity to opioid.However,the effect of increased sensitivity to opioids in patients with OSAS remains controversial.This study aims to investigate whether male patients with moderate to severe OSAS have increased sensitivity to opioid remifentanil and its related predictive factors,so as to provide a reference for the rational use of opioids in patients with OSAS.Methods:This study was a prospective study.From December 28,2021 to October 15,2022,a total of 61 male patients aged 22 to 60 years old,American Society of Anesthesiologists(ASA)status I and II,who underwent nasopharyngeal surgery under general anesthesia,were selected.According to STOP-BANG questionnaire score and apnea-hypopnea index(AHI),the patients were divided into an OSAS group(n=39)and a control group(n=22).The pupil diameter(PD)of the patients was measured by hand-held monocular pupillometer,and the perception threshold(PT)and pain tolerance threshold(PTT)of the patients were measured by somatosensory evoked potential stimulator.The initial PD,PT,and PTT were measured in a quiet environment and recorded as PD0,PT0,and PTT0.Changes in PD,PT,PTT,respiration,and consciousness were recorded after remifentanil infusion.Age,body mass index(BMI),smoking,AHI,minimal oxygen saturation,and percentage of sleep time spent with oxygen saturation<90%(T90)were included as independent variables in multiple linear regression equations to analyze the possible predictors of increased opioid sensitivity in patients with moderate to severe OSAS.Results:There were no significant differences in PD0,PT0 and PTT0 between the OSAS group and the control group(all P>0.05).After remifentanil infusion,there was no significant difference in the rate of PT change between the 2 groups(P>0.05).The change rate of PTT and PD in the OSAS group was significantly higher than that in the control group(P<0.05 and P<0.001,respective
作者
陈佳
梅喜
CHEN Jia;MEI Xi(Department of Anesthesiology,Third Xiangya Hospital,Central South University,Changsha 410013,China)
出处
《中南大学学报（医学版）》
CAS
CSCD
北大核心
2023年第3期347-355,共9页
Journal of Central South University ：Medical Science
基金
湖南省自然科学基金(2021JJ40940)。
