Gupta Kapil, Prasad Arun, Nagappa Mahesh, Wong Jean, Abrahamyan Lusine, Chung Frances F
Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto.
Department of Anesthesia & Perioperative Medicine, London Health Sciences Centre and St. Joseph Healthcare, Western University, London.
Curr Opin Anaesthesiol. 2018 Feb;31(1):110-119. doi: 10.1097/ACO.0000000000000541.
The primary objective of this review is to identify the risk factors for opioid-induced respiratory depression (OIRD) in the postoperative period.
In the postoperative period, OIRD has often been reported resulting in morbidity and mortality. The risk factors which predispose surgical patients to increased risk of OIRD are not clearly defined. A literature search was performed for adult surgical patients who were prescribed opioids during their hospital stay and any available reports on postoperative respiratory depression/respiratory events.
Elderly, female sex, presence of obstructive sleep apnea, chronic obstructive pulmonary disease, cardiac disease, diabetes mellitus, hypertension, neurologic disease, renal disease, obesity, two or more comorbidities, opioid dependence, use of patient controlled analgesia, different routes of administration of opioids and concomitant administration of sedatives are significant risk factors for postoperative OIRD. The majority of patients with OIRD are deeply sedated and inadequately monitored. In patients with underlying risk factors, the dose of opioids should be carefully titrated. Enhanced monitoring of sedation level, respiratory rate, pulse oximetry and capnography is needed in the first 24 h after surgery.
本综述的主要目的是确定术后阿片类药物引起的呼吸抑制（OIRD）的危险因素。
在术后阶段，经常有关于OIRD导致发病和死亡的报道。使外科手术患者易患OIRD风险增加的危险因素尚未明确界定。对住院期间开具阿片类药物的成年外科手术患者以及任何有关术后呼吸抑制/呼吸事件的现有报告进行了文献检索。
老年人、女性、存在阻塞性睡眠呼吸暂停、慢性阻塞性肺疾病、心脏病、糖尿病、高血压、神经系统疾病、肾脏疾病、肥胖、两种或更多种合并症、阿片类药物依赖、使用患者自控镇痛、阿片类药物的不同给药途径以及同时使用镇静剂是术后OIRD的重要危险因素。大多数OIRD患者深度镇静且监测不足。对于有潜在危险因素的患者，应仔细滴定阿片类药物的剂量。术后24小时内需加强对镇静水平、呼吸频率、脉搏血氧饱和度和二氧化碳描记图的监测。
