CAJ | 학술논문

目的：探讨纳美芬对腹腔镜胆囊切除术患者术后呼吸抑制的拮抗作用。方法将110例行腹腔镜胆囊切除术患者根据术后使用拮抗药物的不同分为 A 组和 B 组，每组55例。A 组在手术结束后5 min 静脉推注盐酸纳美芬注射液0．25μg·kg－1，B 组在手术结束后5 min 静脉推注纳洛酮1μg·kg－1。观察2组给予拮抗药前，给予拮抗药后2、10 min，拔管后5 min 收缩压（SBP）、舒张压（DBP）、心率（HR）、平均动脉压（MAP）和血氧饱和度（SpO2）的变化以及给予拮抗药后10 min 呼吸恢复率、拔管时间和不良反应（包括躁动、高血压、心动过速、过敏反应和肺水肿）的情况，并对2组拔管后5 min 意识状况及拔管后30 min 镇痛情况进行评分（分别采用 Ramsay 和VAS 评分）。结果A 组拔管时间为（5．4±0．3）min，B 组拔管时间为（6．1±0．4）min，2组比较差异无统计学意义（P ＞0．05）。2组给予拮抗药后2、10 min 和拔管后5 min 时 SBP、DBP、SpO2比较差异均无统计学意义（均 P ＞0．05），A 组给予拮抗药后10 min 呼吸恢复率明显高于 B 组（P ＜0．05），2组拔管后30 min VAS 和拔管后5 min Ramsay 得分比较差异均无统计学意义（均 P ＞0．05）。A 组恶心、躁动、转氨酶升高1例（1．8％），B 组恶心、躁动、转氨酶升高2例（3．6％），2组比较差异无统计学意义（P ＞0．05）。结论纳美芬可安全、有效地拮抗腹腔镜胆囊切除术患者术后引起的呼吸抑制，且患者呼吸恢复率优于纳洛酮。
목적：탐토납미분대복강경담낭절제술환자술후호흡억제적길항작용。방법장110례행복강경담낭절제술환자근거술후사용길항약물적불동분위 A 조화 B 조，매조55례。A 조재수술결속후5 min 정맥추주염산납미분주사액0．25μg·kg－1，B 조재수술결속후5 min 정맥추주납락동1μg·kg－1。관찰2조급여길항약전，급여길항약후2、10 min，발관후5 min 수축압（SBP）、서장압（DBP）、심솔（HR）、평균동맥압（MAP）화혈양포화도（SpO2）적변화이급급여길항약후10 min 호흡회복솔、발관시간화불량반응（포괄조동、고혈압、심동과속、과민반응화폐수종）적정황，병대2조발관후5 min 의식상황급발관후30 min 진통정황진행평분（분별채용 Ramsay 화VAS 평분）。결과A 조발관시간위（5．4±0．3）min，B 조발관시간위（6．1±0．4）min，2조비교차이무통계학의의（P ＞0．05）。2조급여길항약후2、10 min 화발관후5 min 시 SBP、DBP、SpO2비교차이균무통계학의의（균 P ＞0．05），A 조급여길항약후10 min 호흡회복솔명현고우 B 조（P ＜0．05），2조발관후30 min VAS 화발관후5 min Ramsay 득분비교차이균무통계학의의（균 P ＞0．05）。A 조악심、조동、전안매승고1례（1．8％），B 조악심、조동、전안매승고2례（3．6％），2조비교차이무통계학의의（P ＞0．05）。결론납미분가안전、유효지길항복강경담낭절제술환자술후인기적호흡억제，차환자호흡회복솔우우납락동。
Objective To evaluate the antagonistic effect of nalmefene on postoperative respira-tory depression in patients undergoing laparoscopic cholecystectomy.Methods A total of 110 pa-tients were given intravenous infusion of nalmefene hydrochloride injection 0.25 μg·kg-1 (group A,n=55)or naloxone 1 μg·kg-1 (group B,n=55)5 minutes after laparoscopic cholecystecto-my.The systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),mean ar-terial pressure(MAP)and blood oxygen saturation(SpO2 )were recorded before administration,2 minutes after administration,10 minutes after administration and 5 minutes after extubation.The respiratory recovery rate,extubation time and adverse reactions(restlessness,hypertension,tachy-cardia,allergic reaction and pulmonary edema)were observed 10 minutes after administration.In addition,consciousness score and analgesic score were determined 5 and 30 minutes after extuba-tion(Ramsay and VAS scores were used).Results The extubation time was(5.4±0.3)minutes in group A and (6.1±0.4)minutes in group B.The difference in extubation time was not signifi-cant between the two groups(P >0.05).In addition,there were no significant differences between the two groups in SBP,DBP and SpO2 2 and 10 minutes after administration and 5 minutes after extubation,as well as in VAS score 30 minutes after extubation and Ramsay score 5 minutes after extubation(P > 0.05 ).Compared with group B,the respiratory recovery rate significantly in-creased in group A 10 minutes after administration(P <0.05).The nausea,restlessness and trans-aminase elevation occurred in 1 patient(1.8%)in group A and 2 patients(3.6%)in group B.The difference in the incidence of adverse reactions was not significant between the two groups(P >0.05).Conclusion Nalmefene is effective and safe for antagonizing the postoperative respiratory depression and results in higher respiratory recovery rate than naloxone in patients undergoing laparoscopic cholecystectomy.