發(fā)布時間：2018-12-28 14:47

【摘要】：目的:研究小劑量納美芬對阻塞性睡眠呼吸暫停低通氣綜合征(OSAHS)患者腭咽成形術(shù)(UPPP)后恢復的影響。方法:選取60例擬于全麻下行腭咽成形術(shù)的OSAHS患者,隨機分為觀察組和對照組,每組30例,觀察組于術(shù)畢時緩慢靜脈注射納美芬0.2ug/kg,對照組靜脈注射生理鹽水2ml。并于術(shù)后2~4h,術(shù)日晚間22點~次日6點使用多導睡眠監(jiān)測儀監(jiān)測低氧指數(shù)(oxygen desaturation index of 4,ODI4)和CT90(血氧飽和度低于90%占總睡眠時間的百分數(shù)(percentage of total sleep time with Sp O290%,CT90)。觀察指標:(1)術(shù)畢患者蘇醒(停藥到清醒)時間、拔管(停藥至拔管)時間;(2)記錄患者術(shù)前、術(shù)后2h~4h、術(shù)日晚20:00~次日6:00時間段ODI4和CT90;(3)術(shù)后2h(T1)、6h(T2)、12h(T3)、24h(T4)的鎮(zhèn)痛的VAS評分和舒適度評分(Bruggrmann Comfort Scale,BCS);(4)術(shù)后30min(T0)、2h(T1)、6h(T2)、12h(T3)、24h(T4)時的MAP(mmhg)、HR(次/分);(5)術(shù)后躁動、譫妄、寒戰(zhàn)、惡心嘔吐的例數(shù)。結(jié)果:兩組各時間點MAP、HR、VAS、BCS水平以及術(shù)后躁動、譫妄、寒戰(zhàn)、惡心嘔吐發(fā)生率無統(tǒng)計學差異(P0.05);觀察組術(shù)后蘇醒時間、拔管時間較對照組短,術(shù)后2~4h、術(shù)日晚間觀察組ODI4、CT90水平低于對照組,差異有統(tǒng)計學意義(P0.05),組內(nèi)比較術(shù)后兩項指標較術(shù)前明顯降低,但夜間睡眠時兩項指標較術(shù)后2~4h時有所升高。結(jié)論:小劑量(0.2ug/kg)納美芬用于OSAHS患者腭咽成形全麻術(shù)后,具有縮短術(shù)畢清醒和拔管時間、減輕術(shù)后低氧血癥的作用、而不影響術(shù)后鎮(zhèn)痛效果,血流動力學穩(wěn)定,有利于患者術(shù)后恢復。
[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.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R614

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