Broens Suzanne Jl, He Xuan, Evley Rachel, Olofsen Erik, Niesters Marieke, Mahajan Ravi P, Dahan Albert, van Velzen Monique
Department of Anesthesiology, Leiden University Medical Centre, Leiden, the Netherlands.
Nottingham University Hospital NHS Trust, Queen's Medical Centre, Nottingham, UK.
Ther Clin Risk Manag. 2017 Aug 26;13:1091-1098. doi: 10.2147/TCRM.S135923. eCollection 2017.
There is limited information on the occurrence of respiratory events in postoperative patients after discharge from the postanesthesia care unit. We studied the respiratory rate (RR) of 68 patients aged 60 years and above during the first 6 hours following elective surgery under general anesthesia to assess the frequency of respiratory events in the care unit and on the ward. RR was derived from the continuous RR counter RespiR8, measuring RR by quantifying the humidity of exhaled air. One-minute-averaged RRs were collected and analyzed to assess the frequency of postoperative bradypnea (RR 1-6 breaths/minute) and apnea (cessation of inspiratory flow ≥60 seconds). Values were median (interquartile range) or mean (SD). The median RR was 13 (10-15) breaths/minute. In the 6-hour postoperative period, 78% and 57% of patients experienced at least one bradypnea or apnea event, respectively. A median of ten (3.5-24) bradypnea and three (1-11) apnea events were detected per patient. The occurrence of respiratory events in the postanesthesia care unit (PACU) was a predictor of events on the ward (bradypnea, =0.4, <0.001; apnea, =0.2, <0.001). Morphine consumption correlated weakly with respiratory events in the PACU, but not on the ward. Patients with apnea had significantly larger neck circumference than patients without (39.6 [0.7] versus 37.4 [0.8] cm, <0.05). Bradypneic or apneic respiratory events are frequent in postoperative elderly patients and even occur relatively late after surgery. Continuous respiratory monitoring on the ward, especially in patients with risk factors, such as early occurrence of events, opioid use, and larger neck circumference, is likely warranted.
关于麻醉后护理单元出院后术后患者呼吸事件的发生情况，相关信息有限。我们研究了68例60岁及以上患者在全身麻醉下择期手术后最初6小时内的呼吸频率（RR），以评估护理单元和病房内呼吸事件的发生频率。RR通过连续RR计数器RespiR8得出，该计数器通过量化呼出气体的湿度来测量RR。收集并分析1分钟平均RR，以评估术后呼吸过缓（RR为1 - 6次/分钟）和呼吸暂停（吸气气流停止≥60秒）的发生频率。数值为中位数（四分位间距）或均值（标准差）。RR中位数为13（10 - 15）次/分钟。在术后6小时内，分别有78%和57%的患者至少经历过一次呼吸过缓或呼吸暂停事件。每位患者检测到的呼吸过缓事件中位数为10（3.5 - 24）次，呼吸暂停事件中位数为3（1 - 11）次。麻醉后护理单元（PACU）中呼吸事件的发生是病房内事件的预测指标（呼吸过缓，=0.4，<0.001；呼吸暂停，=0.2，<0.001）。吗啡用量与PACU中的呼吸事件相关性较弱，但与病房内事件无关。发生呼吸暂停的患者颈围明显大于未发生呼吸暂停的患者（39.6 [0.7] 对37.4 [0.8] cm，<0.05）。呼吸过缓或呼吸暂停性呼吸事件在术后老年患者中很常见，甚至在术后较晚时间也会发生。病房内持续的呼吸监测，尤其是对有危险因素的患者，如事件早期发生、使用阿片类药物和颈围较大的患者，可能是必要的。
