Duarte Leonardo Teixeira Domingues, Fernandes Maria do Carmo Barretto de Carvalho, Costa Verônica Vieira da, Saraiva Renato Angelo
Hospital SARAH, Brasília.
Rev Bras Anestesiol. 2009 Jul-Aug;59(4):409-20. doi: 10.1590/s0034-70942009000400003.
Intravenous or epidural patient-controlled analgesia (PCA) is a safe and effective technique in the treatment of postoperative pain. However, the use of opioids is not devoid of risks,and respiratory depression represents the most feared complication. The objective of the present study was to describe the incidence of respiratory depression associated with postoperative analgesia with the intravenous or epidural administration of opioids and the characteristics of the patients who developed this complication.
This is a retrospective, incidence study in patients who underwent surgeries at the Hospital SARAH Brasília from December 1999 to December 2007 and treated with intravenous or epidural PCA with opioids. Respiratory depression was defined as: respiratory rate < 8 bpm, need to use naloxone, or peripheral oxygen saturation below 90%.
Two thousand seven hundred and ninety patients were evaluated; 635 of those patients received intravenous PCA and 2155 epidural analgesia. Seven patients developed postoperative respiratory depression (0.25%). Six of those patients were treated with intravenous PCA with morphine, while the last one received epidural analgesia with fentanyl. Patients had a mean age of 30.5 +/- 24.7 years; the mean time between the end of anesthesia and the development of respiratory depression was 18.1 +/- 26.3 hours. The incidence of respiratory depression was significantly higher in PCA with intravenous morphine (p = 0.001) and age below 16 years (p < 0.05).
The incidence of respiratory depression was similar to that described in the literature; it is more frequent in children and adolescents, and with intravenous PCA.
静脉或硬膜外患者自控镇痛（PCA）是治疗术后疼痛的一种安全有效的技术。然而，使用阿片类药物并非没有风险，呼吸抑制是最令人担忧的并发症。本研究的目的是描述与静脉或硬膜外使用阿片类药物进行术后镇痛相关的呼吸抑制发生率，以及发生该并发症的患者特征。
这是一项回顾性发病率研究，研究对象为1999年12月至2007年12月在巴西利亚莎拉医院接受手术并采用静脉或硬膜外阿片类药物PCA治疗的患者。呼吸抑制的定义为：呼吸频率<8次/分钟、需要使用纳洛酮或外周血氧饱和度低于90%。
共评估了2790例患者；其中635例患者接受静脉PCA，2155例接受硬膜外镇痛。7例患者发生术后呼吸抑制（0.25%）。其中6例患者接受静脉吗啡PCA治疗，最后1例接受芬太尼硬膜外镇痛。患者的平均年龄为30.5±24.7岁；麻醉结束至发生呼吸抑制的平均时间为18.1±26.3小时。静脉注射吗啡PCA组（p = 0.001）和年龄低于16岁组（p < 0.05）的呼吸抑制发生率显著更高。
呼吸抑制的发生率与文献报道相似；在儿童和青少年中以及静脉PCA时更为常见。
