小剂量纳美芬对阻塞性睡眠呼吸暂停低通气综合征患者腭咽成形术后恢复的影响

发布时间：2018-12-28 14:47

【摘要】：目的:研究小剂量纳美芬对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者腭咽成形术(UPPP)后恢复的影响。方法:选取60例拟于全麻下行腭咽成形术的OSAHS患者,随机分为观察组和对照组,每组30例,观察组于术毕时缓慢静脉注射纳美芬0.2ug/kg,对照组静脉注射生理盐水2ml。并于术后2~4h,术日晚间22点~次日6点使用多导睡眠监测仪监测低氧指数(oxygen desaturation index of 4,ODI4)和CT90(血氧饱和度低于90%占总睡眠时间的百分数(percentage of total sleep time with Sp O290%,CT90)。观察指标:(1)术毕患者苏醒(停药到清醒)时间、拔管(停药至拔管)时间;(2)记录患者术前、术后2h~4h、术日晚20:00~次日6:00时间段ODI4和CT90;(3)术后2h(T1)、6h(T2)、12h(T3)、24h(T4)的镇痛的VAS评分和舒适度评分(Bruggrmann Comfort Scale,BCS);(4)术后30min(T0)、2h(T1)、6h(T2)、12h(T3)、24h(T4)时的MAP(mmhg)、HR(次/分);(5)术后躁动、谵妄、寒战、恶心呕吐的例数。结果:两组各时间点MAP、HR、VAS、BCS水平以及术后躁动、谵妄、寒战、恶心呕吐发生率无统计学差异(P0.05);观察组术后苏醒时间、拔管时间较对照组短,术后2~4h、术日晚间观察组ODI4、CT90水平低于对照组,差异有统计学意义(P0.05),组内比较术后两项指标较术前明显降低,但夜间睡眠时两项指标较术后2~4h时有所升高。结论:小剂量(0.2ug/kg)纳美芬用于OSAHS患者腭咽成形全麻术后,具有缩短术毕清醒和拔管时间、减轻术后低氧血症的作用、而不影响术后镇痛效果,血流动力学稳定,有利于患者术后恢复。
[Abstract]:Aim: to study the effect of low dose namefen on (UPPP) recovery after palatopharyngoplasty in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: sixty patients with OSAHS undergoing palatopharyngoplasty under general anesthesia were randomly divided into two groups: observation group (n = 30) and control group (n = 30). The hypoxic index (oxygen desaturation index of _ 4 ODI4) and CT90 (less than 90% of total sleep time (percentage of total sleep time with Sp O _ 290T _ (90) were monitored by polysomnography at 2h and 4h after operation from 22:00 to 6am on the day of operation. Observation measures: (1) the time of recovery (from drug withdrawal to waking), the time of extubation (from drug withdrawal to extubation) at the end of operation, (2) the ODI4 and CT90; were recorded before and 2 hours after operation, and between 20: 00 p.m. and 6:00 the next day. (3) VAS score and comfort score (Bruggrmann Comfort Scale,BCS) at 2h (T1), 6h (T2), 12h (T3), 24h (T4) after operation; (4) the cases of restlessness, delirium, shivering, nausea and vomiting after 30min (T0), 2h (T1), 6h (T2), 12h (T3), 24h (T4). Results: there was no significant difference in the level of MAP,HR,VAS,BCS and the incidence of restlessness, delirium, shivering, nausea and vomiting between the two groups at different time points (P0.05). The postoperative recovery time and extubation time in the observation group were shorter than those in the control group. The level of ODI4,CT90 in the observation group was significantly lower than that in the control group at 2 hours after operation (P0.05). However, the two indexes of nocturnal sleep were higher than those of 24 hours after operation. Conclusion: low dose (0.2ug/kg) natmefen in patients with OSAHS after palatopharyngoplasty general anesthesia can shorten the time of postoperative wake and extubation, reduce hypoxemia, but not affect the postoperative analgesic effect, hemodynamics is stable. It is beneficial to the recovery of patients after operation.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614

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