CAJ | 학술논문

目的评价纳美芬拮抗阿片类药物术后呼吸抑制的效果.方法采用多中心、随机、双盲、阳性药物对照研究的方法,选择拟在阿片类药物复合麻醉下的非肝脏、肾脏和神经外科手术的择期手术(手术时间≤3 h)患者,手术结束后存在无肌松药残留作用的呼吸抑制患者240例,年龄18～64岁,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分为纳洛酮组和纳美芬组,每组120例.两组分别经30 s静脉注射纳洛酮0.1 mg、纳美芬0.25 μg/kg,5 min后可重复给药1次,直至呼吸频率＞10次/min和PⅡCO2＜45 mm Hg且呼吸暂停时间＜15 s,停止给药,累积剂量纳洛酮不超过0.4 mg,纳美芬不超过1 μg/kg.分别于给药前即刻、给药后2、5 min、随后每间隔5 min记录BP、HR、SpO2、PETCO2、呼吸频率、呼吸暂停时间,直至拔除气管导管后5 min.记录给药后30 min内呼吸恢复情况,记录给药后呼吸恢复时间及拔除气管导管时间和拔除气管导管后5 min时Ramsay镇静评分,记录恶心、呕吐、伤口疼痛等不良反应的发生情况.结果两组给药后30 min内呼吸恢复率均为100%;与纳洛酮组比较,纳美芬组拨除气管导管时间缩短(P＜0.01),Ramsay镇静评分、BP、HR、SpO2变化值及不良反应发生率差异无统计学意义(P＞0.05).结论纳美芬拮抗阿片类药物诱发术后患者呼吸抑制作用的效果较好.
목적 평개납미분길항아편류약물술후호흡억제적효과.방법 채용다중심、수궤、쌍맹、양성약물대조연구적방법,선택의재아편류약물복합마취하적비간장、신장화신경외과수술적택기수술(수술시간≤3 h)환자,수술결속후존재무기송약잔류작용적호흡억제환자240례,년령18～64세,ASA분급Ⅰ혹Ⅱ급,채용수궤수자표법,장환자수궤분위납락동조화납미분조,매조120례.량조분별경30 s정맥주사납락동0.1 mg、납미분0.25 μg/kg,5 min후가중복급약1차,직지호흡빈솔＞10차/min화PⅡCO2＜45 mm Hg차호흡잠정시간＜15 s,정지급약,루적제량납락동불초과0.4 mg,납미분불초과1 μg/kg.분별우급약전즉각、급약후2、5 min、수후매간격5 min기록BP、HR、SpO2、PETCO2、호흡빈솔、호흡잠정시간,직지발제기관도관후5 min.기록급약후30 min내호흡회복정황,기록급약후호흡회복시간급발제기관도관시간화발제기관도관후5 min시Ramsay진정평분,기록악심、구토、상구동통등불량반응적발생정황.결과 량조급약후30 min내호흡회복솔균위100%;여납락동조비교,납미분조발제기관도관시간축단(P＜0.01),Ramsay진정평분、BP、HR、SpO2변화치급불량반응발생솔차이무통계학의의(P＞0.05).결론 납미분길항아편류약물유발술후환자호흡억제작용적효과교호.
Objective To evaluate the efficacy of nalmefene antagonizing postoperative respiratory depression induced by opioids.Methods Two hundred and forty ASA Ⅰ orⅡpatients aged 18-64 yr with body weight fluctuating within 20% of the standard body weight were included in this multicenter,randomized,double-blind,positive drug-controlled study.Anesthesia was induced with etomidate 0.3 mg/kg and TCI of sufentanil(effect-site concentration 0.4.ng/ml).Tracheal intubation was facilitated with vecuronium 0.1 mg/kg or rocuronium 0.6mg/kg.The patients were mechanically ventilated.PETCO2 was maintained at 35-45 mm Hg.Anesthesia was maintained with sevoflurane+ sufentanil TCI(Ce=0.1-0.4 ng/ml).Patients undergoing neurosurgery and liver or kidney operation were excluded.The operation time was within 3 h.The residual effects of muscle relaxants were reversed after operation.The patients were randomly divided into 2 groups(n=120 each):group Ⅰneloxone andgroup Ⅱ nalmefene.Naloxone 0.1 mg or nalmefene 0.25 μg/kg was injected iv over 30 s and was repeated 5 min later if necessary until the respiratory rate＞10 bpm,PETCO2＜45 mm Hg and apnea time＜15 s.The total amount of naloxone was≤0.4 mg while that of nalmefene≤1 μg/kg.BP,HR,SpO2,PETCO2,respiratory rate and apnea time were recorded immediately before and at 2 and 5 min after haloxone/nalmefene administration and then every 5 min until 5 min after extubation.The recovery of spontaneous breathing within 30 min after naloxone/nalmefene administration,extubation time and Ramsay sedation score at 5 min after extubation were recorded.The patients were also observed for adverse reactions.Results Spontaneous breathing recovered within 30 min after naloxone/nalmefene administration in all patients in both groups.The extubation time was significantly shorter in nalmefene group than in naloxone group.There was no significant difference in Ramsay sedation score,BP,HR,SpO2 and incidence of adverse reactions between the 2 groups.Conclusion Nalmefene is better than naloxone in antagonizing opioid-induced postoperative respiratory depression.