嗜睡症患者围术期全麻风险：病例对照研究
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Perioperative risks of narcolepsy in patients undergoing general anesthesia: A case-control study
背景与目的
比较进行麻醉管理的嗜睡病患者和匹配对照组的围手术期结果
方 法
设计：回顾性2：1匹配研究设计
设置：大型三级医疗中心
患者：从2011年1月1日至2015年9月30日接受全身麻醉的嗜睡症的患者与对照组年龄，性别，手术类型相符合
测量：对麻醉I阶段恢复期的呼吸抑制发作及其他有意义的围手术期结果的病历进行了回顾
结 果
对 76例发作性睡眠患者及其对照组进行了围术期检查。与对照组相比较，嗜睡症患者经常被开具中枢神经系统兴奋剂（73.7%vs4.0%，P＜0.001）和抗抑郁药（46.1%vs27.6%，P=0.007），经常出现呼吸睡眠暂停综合征(40.8% vs19.1%, P＜0.001)。术中病程相似。呼吸抑制发作次数在嗜睡症患者和对照组之间没有差异（分别为5 [6.6％] vs 12 [7.9％]，P = 0.80）。与对照组相比，嗜睡症患者的应急反应触发频率较高（76例[6.6％中有5例（6.6％），95％CI，2.2％-14.7％）（152例（1.3％），95％CI，0.2％-4.7 ％）（P = 0.04）。除了1型（猝发睡眠），应激反应暗示血液动力学不稳定，这是由于过度的镇静与呼吸抑制所导致。
结 论
嗜睡症患者术中反应与对照组相似，包括I期麻醉恢复。 然而，他们的应急反应触发率高于对照组，这表明嗜睡症患者的围手术期风险可能增加。
原始文献摘要
Cavalcante A N, Hofer R E, Tippmann-Peikert M, et al. Perioperative risks of narcolepsy in patients undergoing general anesthesia: A case-control study[J]. Journal of Clinical Anesthesia, 2017.
Study objective:To compare the perioperative outcomes between patients with narcolepsy and matched controls undergoing anesthetic management.
Design: Retrospective 2:1 matched study design.
Setting: Large tertiary medical center.
Patients: Narcoleptic patients who underwent general anesthesia from January 1, 2011, through September 30, 2015, were matched with controls by age, sex, and type and year of surgery.
Measurements: Medical records were reviewed for episodes of respiratory depression during phase I recovery and for other meaningful perioperative outcomes.
Main results: The perioperative courses of 76 narcoleptic patients and their controls were examined. Compared to controls, narcoleptic patients were more often prescribed central nervous system stimulants (73.7% vs 4.0%, P＜0.001) and antidepressants (46.1% vs 27.6%, P = 0.007) and more often had obstructive sleep apnea (40.8% vs 19.1%, P＜0.001). The intraoperative course was similar. The number of episodes of respiratory depression was not different between patients and controls (5 [6.6%] vs 12 [7.9%], respectively; P = 0.80). Narcoleptic patients had a higher frequency of emergency response team activations (5 of 76 [6.6%]; 95% CI, 2.2%–14.7%) compared to controls (2 of 152 [1.3%]; 95% CI, 0.2%–4.7%) (P = 0.04). Hemodynamic instability was the indication for all emergency response team activations except 1, which was for a narcoleptic patient who had excessive postoperative sedation and respiratory depression.
Conclusions: Narcoleptic patients had similar intraoperative courses as the matched controls, including phase I anesthetic recovery. However, they had a higher rate of emergency response team activations than the controls, which suggests that patients with narcolepsy may be at increased perioperative risk.
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