阻塞性睡眠呼吸暂停低通气综合征术后镇痛的临床应用

目的 选择出更合理的针对阻塞性睡眠呼吸暂停低通气综合(OSAHS)术后镇痛用药。方法 择期ASAⅠ～Ⅱ级阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者68例,均在气管内插管全麻下行悬雍垂腭咽成形术(UPPP),术中均用丙泊酚+瑞芬太尼维持麻醉,术后随机分为2组,实验组(A组)36例应用地佐辛25 mg+氟比洛芬酯100 mg+舒芬太尼1 g/kg/h ;对照组(B组)32例应用舒芬太尼3 g/kg/h。观察患者OSAHS术后苏醒时间的长短、是否有窒息的情况的发生。分别观察和记录两组患者拔管后到完全苏醒的时间和舒适度(患者对疼痛程度的评价)。记录术后1、4、8、12、24、48 h镇痛评分(VAS)、舒适度评分(BCS),对比评价。结果 实验组术后各时点VAS评分、BCS评分与对照组相当,两组间比较无显著性差异(P>0.05);实验组发生窒息、呼吸抑制、恶心、呕吐等不良反应的机率低于对照组(P<0.01)。结论 舒芬太尼、地佐辛、氟比洛芬酯联合用于OSAHS术后镇痛,不仅可以提供满意的镇痛,明显减少苏醒拔管后窒息、呼吸抑制的发生,而且通过联合使用非甾体类抗炎药,降低了手术创伤引起的痛觉过敏状态,减少渗出,抑制炎症反应,是一种安全有效的配伍方法。

Clinical application of postoperative analgesia withobstructive sleep apnea-hypopnea syndrome

Objective To select a more reasonable analgesic medication for obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Sixty-eight patients obstructive sleep apnea-hypopnea syndrome (OSAHS) with ASA I-II underwent uvulopalatopharyngoplasty (UPPP) under tracheal intubation. During the operation, propofol and remifentanil were used to maintain anesthesia. They were randomly divided into two groups. In the experimental group (A group), 36 patients received dizocine 25 mg + flurbiprofen axetil 100 mg + sufentanil 1 g/kg/h; control group (B group) 32 patients received application sufentanil 3 g/kg/h. Observe the length of time the patient wakes up after OSAHS and whether there is a suffocation. The time to complete awakening and comfort (examination of the patient's pain) after extubation were observed and recorded separately. The postoperative pain scores (VAS) and comfort scores (BCS) were recorded at 1, 4, 8, 12, 24, and 48 h after surgery and compared. Results The VAS score and BCS score of the experimental group were comparable to the control group at all-time points after the operation. There was no significant difference between the two groups (P>0.05). The incidence of adverse reactions such as asphyxia, respiratory depression, nausea, and vomiting was lower in the experimental group than in the control group (P<0.01). Conclusion Sufentanil, dezocine combined with flurbiprofen axetil for OSAHS postoperative analgesia can not only provide satisfactory analgesia, but also significantly reduce the occurrence of asphyxia and respiratory depression after awakening extubation. In addition, the use of non-steroidal anti-inflammatory drugs in combination reduces the hyperalgesia induced by surgical trauma, reduces exudation, and suppresses inflammatory reactions. It is a safe and effective method of compatibility.