阻塞性睡眠呼吸暂停患者术后氧疗：一项随机对照试验

Postoperative Oxygen Therapy in Patients With OSA: A Randomized Controlled Trial.

作者信息

Liao Pu, Wong Jean, Singh Mandeep, Wong David T, Islam Sazzadul, Andrawes Maged, Shapiro Colin M, White David P, Chung Frances

机构信息

Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.

Department of Psychiatry, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.

出版信息

Chest. 2017 Mar;151(3):597-611. doi: 10.1016/j.chest.2016.12.005. Epub 2016 Dec 19.

DOI:10.1016/j.chest.2016.12.005

PMID:28007620

Abstract

BACKGROUND

Surgical patients with OSA are at increased risk for perioperative complications. Postoperative supplemental oxygen is commonly used, but it may contribute to respiratory depression in patients with OSA receiving opioids. The objective of the study is to investigate the effect of postoperative supplemental oxygen on arterial oxygen saturation (Sao), sleep respiratory events, and CO level in patients with untreated OSA.

METHODS

Consented patients with an apnea hypopnea index (AHI) > 5 events per hour on a preoperative polysomnography were randomized (1:1) to oxygen (O group) or no oxygen (control group). The O group received oxygen at 3 L/min via nasal prongs for three postoperative nights. The primary outcomes were polysomnographic parameters measuring Sao, sleep respiratory events, and Pco measured by transcutaneous CO monitor (PCO) on nights 1 through 3. The intention-to-treat and per protocol analysis were completed.

RESULTS

There were 123 patients randomized (O group: n = 62; control group: n = 61). On night 3, the O vs control group had a higher average Sao (95.2% ± 3% vs 91.4% ± 4%, respectively; P < .001) and lower oxygen desaturation index (median, 2.3; 25th-75th percentile, 0.2-13.8 vs median, 18.5; 25th-75th percentile, 8.2-45.9 events per hour, respectively; P < .0001). The O group had a decreased AHI (median, 8.0; 25th-75th percentile, 2.1-19.9 vs median, 15.6; 25th-75th percentile, 9.5-45.8, respectively; P = .016), hypopnea index (P < .001), and central apnea index (P = .026) and a shortened longest apnea hypopnea duration (P = .002). Although time percentage with PCO ≥ 55 mm Hg ≥ 10% on postoperative night 1, 2, or 3 was found in 11.4% patients, there was no difference in PCO between the groups.

CONCLUSIONS

Postoperative supplemental oxygen was found to improve oxygenation and decrease the AHI without increasing the duration of apnea-hypopnea event or PCO level. A small number of patients had significant CO retention while receiving supplemental oxygen.

TRIAL REGISTRY

ClinicalTrials.gov; No.: NCT01552304; URL: www.clinicaltrials.gov.

摘要

背景

患有阻塞性睡眠呼吸暂停（OSA）的外科手术患者围手术期并发症风险增加。术后通常会补充氧气，但这可能会导致接受阿片类药物治疗的OSA患者出现呼吸抑制。本研究的目的是调查术后补充氧气对未经治疗的OSA患者动脉血氧饱和度（Sao）、睡眠呼吸事件和二氧化碳（CO）水平的影响。

方法

术前多导睡眠图检查显示呼吸暂停低通气指数（AHI）>5次/小时且已签署知情同意书的患者被随机（1:1）分为吸氧组（O组）或不吸氧组（对照组）。O组术后连续三晚通过鼻导管以3L/分钟的速度吸氧。主要结局指标为第1至3晚通过多导睡眠图测量的Sao、睡眠呼吸事件以及经皮CO监测仪（PCO）测量的二氧化碳分压（Pco）。完成了意向性分析和符合方案分析。

结果

共有123例患者被随机分组（O组：n = 62；对照组：n = 61）。在第3晚，O组与对照组相比，平均Sao更高（分别为95.2%±3%和91.4%±4%；P <.001），氧去饱和指数更低（中位数分别为每小时2.3次；第25至75百分位数为0.2至13.8次与中位数每小时18.5次；第25至75百分位数为8.2至45.9次；P <.0001）。O组的AHI降低（中位数分别为8.0；第25至75百分位数为2.1至19.9与中位数15.6；第25至75百分位数为9.5至45.8；P =.016），低通气指数（P <.001）和中枢性呼吸暂停指数（P =.026）降低，最长呼吸暂停低通气持续时间缩短（P =.002）。尽管在术后第1、2或3晚发现11.4%的患者二氧化碳分压≥55mmHg的时间百分比≥10%，但两组之间的二氧化碳分压没有差异。