椎管内麻醉后丙泊酚镇静下持续正压面罩通气对阻塞性睡眠呼吸暂停综合征高危患者的影响
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Effects of continuous positive airway pressure in patients at high risk of obstructive sleep apnea during propofol sedation after spinal anesthesia
背景与目的
在阻塞性睡眠呼吸暂停患者中，短期使用持续气道正压面罩通气可改善氧合、降低呼吸暂停低通气指数、并减少血液动力学不稳定性。本研究旨在探讨椎管内麻醉后丙泊酚镇静下持续气道正压通气对阻塞性睡眠呼吸暂停综合征高危患者的影响。
方 法
40例椎管内麻醉后接受丙泊酚镇静的择期行经尿道膀胱或前列腺电切术患者，STOP-Bang评分3分以上，随机分为两组：单纯氧气面罩通气组（n=20）和持续气道正压面罩通气组（n=20）。椎管内麻醉后，通过靶浓度控制丙泊酚靶浓度1.3mcg/ml，单纯氧气面罩通气组患者通过简单的面罩以6 L/min的速度给氧，持续气道正压面罩通气组的患者连接加压器，并给予氧气（6L/min，5-15cm H2O）。分别于术前、椎管内麻醉后及注射丙泊酚后每5分钟记录血压、心率、呼吸频率、血氧饱和度，观察血流动力学变化。使用Apnea-Link估计呼吸暂停通气指数。
结 果
两组间血流动力学变化无显著差异。持续气道正压通气组与单纯面罩组相比，呼吸暂停低通气指数明显降低。
结 论
对阻塞性睡眠呼吸暂停高危患者应用持续气道正压面罩通气可降低镇静期间阻塞性睡眠呼吸暂停的发生率，且对血流动力学的稳定性无显著影响。
原始文献摘要
Lim H , Oh M , Chung Y H , et al. Effects of continuous positive airway pressure in patients at high risk of obstructive sleep apnea during propofol sedation after spinal anesthesia[J]. Journal of Clinical Monitoring and Computing, 2018.
Bckground: In patients with obstructive sleep apnea, short-term use of a continuous positive airway pressure mask improves oxygenation,decreases the apnea-hypopnea index, and reduces hemodynamic instability. In this study, we investigated the effects of use of a continuous positive airway pressure mask in patients at high risk of obstructive sleep apnea during propofol sedation after spinal anesthesia.
Methods: Forty patients who underwent propofol sedation after spinal anesthesia for transurethral bladder or prostate resection with a STOP-Bang score of 3 or more were enrolled in this study. Patients were randomly divided into two groups: a simple oxygen mask group (n = 20) and a continuous positive airway pressure mask group (n = 20). After spinal anesthesia, propofol was injected at a target concentration of 1.3 mcg/ml via a target concentration control injector.ApneaLink™ was applied to all patients. Patients in the simple oxygen mask group were administered oxygen at a rate of 6 L/min through a simple facial mask. Patients in the CPAP mask group were connected to a pressurizer, and oxygen (6 L/min, 5–15 cm H2O) was administered. Blood pressure, heart rate, respiratory rate, and oxygen saturation were recorded preoperatively, after spinal anesthesia, and every 5 min after the injection of propofol to observe hemodynamic changes. Apnea-hypopnea index was estimated using ApneaLink™.
Results: There were no significant differences in hemodynamic changes between the two groups. Apnea-hypopnea index was significantly reduced in the continuous positive airway pressure mask group compared to the simple facial mask group.
Conclusions: Application of a continuous positive airway pressure mask in a patient at high risk of obstructive sleep apnea can lower the incidence of obstructive sleep apnea during sedation without a significant effect on hemodynamic stability.
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编辑：王贵龙 审校：李华宇