【罂粟摘要】短效麻醉剂与标准麻醉剂对阻塞性睡眠呼吸暂停综合征的影响：一项随机、对照、三盲试验
短效麻醉剂与标准麻醉剂对阻塞性睡眠呼吸暂停综合征的影响：一项随机、对照、三盲试验
翻译：佟睿 编辑：佟睿 审校：曹莹
贵州医科大学 高鸿教授课题组
睡眠呼吸暂停综合征与全身麻醉后不良结果有关。目前建议使用短效麻醉剂而非标准药物来降低这种风险，但没有证据支持这一观点。这项随机对照的三盲试验验证了如下假设：与标准药物(七氟烷-芬太尼)相比，短效药物(地氟烷-瑞芬太尼)的组合将降低全身麻醉术后睡眠呼吸暂停的严重程度。60例在全麻下接受髋关节置换术的患者被随机分为地氟烷-芬太尼和七氟烷-芬太尼两组。分别在手术前、术后第一、三晚进行呼吸多谱勒检查。主要观察指标是术后第一晚的仰卧位呼吸暂停-低通气指数。次要观察指标为术后第3晚仰卧位呼吸暂停低通气指数，术后第1、3晚氧减饱和度指数。其他观察指标包括术后第1天、第2天和第3天静脉注射吗啡当量用量和疼痛评分。两组间术前睡眠研究数据相似。术后第1晚短效麻醉组和标准麻醉组的平均仰卧呼吸暂停指数(95%CI)分别为每小时18.9次(12.7-25.0)和21.4次(14.2-28.7)，即事件·h-1(p=0.64)。术后第3晚的对应值分别为每小时28.1次(15.8~40.3)和38.0次(18.3~57.6)，即事件·h-1(p=0.34)。在两组中，与睡眠和疼痛相关的次要观察指标大体上相似。总而言之，与标准麻醉剂相比，短效麻醉剂并不能降低全身麻醉对睡眠呼吸暂停严重程度的影响。这些数据应该会促使当前的建议的更新。
Impact of short-acting vs. standard anaesthetic agents on obstructive sleep apnoea: a randomised, controlled, triple-blind trial
Sleep apnoea is associated with negative outcomes following general anaesthesia. Current recommendations suggest using short-acting anaesthetic agents in preference to standard agents to reduce this risk, but there is currently no evidence to support this. This randomised controlled triple-blind trial tested the hypothesis that a combination of short-acting agents (desflurane-remifentanil) would reduce the postoperative impact of general anaesthesia on sleep apnoea severity compared with standard agents (sevoflurane-fentanyl). Sixty patients undergoing hip arthroplasty under general anaesthesia were randomised to anaesthesia with desfluraneremifentanil or sevoflurane-fentanyl. Respiratory polygraphy was performed before surgery and on the first and third postoperative nights. The primary outcome was the supine apnoea-hypopnoea index on the first postoperative night. Secondary outcomes were the supine apnoea-hypopnoea index on the third postoperative night, and the oxygen desaturation index on the first and third postoperative nights. Additional outcomes included intravenous morphine equivalent consumption and pain scores on postoperative days 1, 2 and 3. Pre-operative sleep study data were similar between groups. Mean (95%CI) values for the supine apnoeahypopnoea index on the first postoperative night were 18.9 (12.7–25.0) and 21.4 (14.2–28.7) events.h-1, respectively, in the short-acting and standard anaesthesia groups (p = 0.64). Corresponding values on the third postoperative night were 28.1 (15.8–40.3) and 38.0 (18.3–57.6) events.h-1(p = 0.34). Secondary sleep- and pain-related outcomes were generally similar in the two groups. In conclusion, short-acting anaesthetic agents did not reduce the impact of general anaesthesia on sleep apnoea severity compared with standard agents. These data should prompt an update of current recommendations.