Department of Paediatric Anaesthesia, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ, UK.
Best Pract Res Clin Anaesthesiol. 2010 Sep;24(3):323-36. doi: 10.1016/j.bpa.2010.04.002.
Premature infants have immature respiratory control that predisposes them to apnoea, haemoglobin oxygen desaturation and bradycardia. Apnoeas are loosely classified, according to the presence or absence of respiratory effort, into central, obstructive or mixed. There are a variety of conditions, in the perioperative period, that predispose an infant to apnoea, including: central nervous system (CNS) lesions, infections and sepsis, ambient temperature fluctuations, cardiac abnormalities, metabolic derangements, anaemia, upper airway structural abnormalities, necrotising enterocolitis, drug administration (including opiates and general anaesthetics) and possibly gastro-oesophageal reflux. Various monitoring techniques are discussed; the mainstay are pulse oximetry and abdominal-pressure transduction. There is some evidence of both short- and long-term complications of repeated apnoeas in the neonatal period, but the causal relationship is difficult to establish. Continuous positive airway pressure and caffeine therapy (up to 10 mg kg(-1)) are the most common treatments of neonatal apnoea. The less soluble volatile agents and regional anaesthetic techniques (without concurrent sedation) are associated with a lower incident of postoperative apnoea.
早产儿的呼吸控制不成熟，容易出现呼吸暂停、血红蛋白氧饱和度降低和心动过缓。呼吸暂停根据是否存在呼吸努力，可分为中枢性、阻塞性或混合性。在围手术期，有多种情况会使婴儿容易出现呼吸暂停，包括：中枢神经系统 (CNS) 病变、感染和败血症、环境温度波动、心脏异常、代谢紊乱、贫血、上呼吸道结构异常、坏死性小肠结肠炎、药物（包括阿片类药物和全身麻醉药）的使用，以及可能的胃食管反流。讨论了各种监测技术；主要是脉搏血氧饱和度和腹部压力转换。新生儿期反复发作呼吸暂停有短期和长期并发症的证据，但因果关系难以确定。持续气道正压通气和咖啡因治疗（高达 10 mg/kg）是新生儿呼吸暂停最常见的治疗方法。较少溶解的挥发性麻醉剂和区域麻醉技术（无同时镇静）与术后呼吸暂停发生率较低相关。
