【罂粟摘要】短效麻醉药物与标准麻醉药物对阻塞性睡眠呼吸暂停的影响：一项随机、对照、三盲试验
短效麻醉药物与标准麻醉药物对阻塞性睡眠呼吸暂停的影响：一项随机、对照、三盲试验
睡眠呼吸暂停与全身麻醉后的不良预后相关。目前通常建议使用短效麻醉药物而不是标准麻醉药物来降低睡眠呼吸暂停风险，但尚无证据支持这一理论。本试验采用随机对照三盲方法验证联合使用短效麻醉药物(地氟烷联合瑞芬太尼)与标准麻醉药物(七氟烷联合芬太尼)相比，全麻术后导致的睡眠呼吸暂停严重程度减轻。60例在全身麻醉下进行髋关节置换术的患者随机实施地氟烷联合瑞芬太尼或七氟烷联合芬太尼麻醉。术前及术后第1、3个晚上行呼吸监测。主要观察指标为术后第1晚仰卧位呼吸暂停-通气不足指数。次要观察指标为术后第3晚仰卧位呼吸暂停-通气不足指数，术后第1晚和第3晚氧饱和度降低指数。其他结果包括术后第1天、第2天和第3天静脉注射吗啡量和疼痛评分。两组患者术前睡眠研究数据相似。短效麻醉药物组和标准麻醉药物组术后第1晚仰卧位呼吸暂停指数的均值(95%CI)分别为18.9(12.7-25.0)和21.4(14.2-28.7)次/小时 (p=0.64)。术后第3晚相应事件为28.1(15.8 -40.3)和38.0 (18.3-57.6)次/小时(p=0.34)。第2晚睡眠和疼痛相关的结果在两组中大体相似。总之，与标准麻醉药物相比，速短效麻醉药物并没有减少全麻后睡眠呼吸暂停严重程度。这些数据应促使对目前的建议进行更新。
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 (desflflurane-remifentanil) would reduce the postoperative impact of general anaesthesia on sleep apnoea severity compared with standard agents (sevoflflurane-fentanyl). Sixty patients undergoing hip arthroplasty under general anaesthesia were randomised to anaesthesia with desflfluraneremifentanil or sevoflflurane-fentanyl. Respiratory polygraphy was performed before surgery and on the fifirst and third postoperative nights. The primary outcome was the supine apnoea-hypopnoea index on the fifirst postoperative night. Secondary outcomes were the supine apnoea-hypopnoea index on the third postoperative night, and the oxygen desaturation index on the fifirst 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 fifirst postoperative night were 18.9 (12.7–25.0) and 21.4 (14.2–28.7) events.h1, 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.h1 (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.
翻译：曹莹 编辑：佟睿 审校：曹莹