Hein Anette, Jakobsson Jan G
Anaesthesia & Intensive Care, Institution for Clinical Sciences, Karolinska Institutet, Danderyds University Hospital, Stockholm, Sweden.
F1000Res. 2017 Nov 29;6:2062. doi: 10.12688/f1000research.13206.2. eCollection 2017.
Obesity, abdominal surgery, and intrathecal opioids are all factors associated with a risk for respiratory compromise. The aim of this explorative trial was to study the apnoea/hypopnea index 1st postoperative night in obese mothers having had caesarean section (CS) in spinal anaesthesia with a combination of bupivacaine/morphine and fentanyl. Consecutive obese (BMI >30 kg/m 2) mothers, ≥18 years, scheduled for CS with bupivacaine/morphine/fentanyl spinal anaesthesia were monitored with a portable polygraphy device Embletta /NOX on 1 postoperative night. The apnoea/hypopnea index (AHI) was identified by clinical algorithm and assessed in accordance to general guidelines; number of apnoea/hypopnea episodes per hour: <5 "normal", ≥5 and <15 , ≥15 and <30 ≥ 30 . Oxygen desaturation events were in similar manner calculated per hour as oxygen desaturation index (ODI). Forty mothers were invited to participate: 27 consented, 23 were included, but polysomnography registration failed in 3. Among the 20 mothers studied: 11 had an AHI <5 ( ), 7 mothers had AHI ≥5 but <15 ( ) and 2 mothers had AHI ≥15 ( ), none had an AHI ≥ 30. The ODI was on average 4.4, and eight patients had an ODI >5. Mothers with a high AHI (15.3 and 18.2) did not show high ODI. Mean saturation was 94% (91-96%), and four mothers had mean SpO 90-94%, none had a mean SpO2 <90%. Respiratory polygraphy 1 night after caesarean section in spinal anaesthesia with morphine in moderately obese mothers showed AHIs that in sleep medicine terms are considered normal, mild and moderate. Obstructive events and episodes of desaturation were commonly not synchronised. Further studies looking at preoperative screening for sleep apnoea in obese mothers are warranted but early postop respiratory polygraphy recording is cumbersome and provided sparse important information.
肥胖、腹部手术和鞘内注射阿片类药物都是与呼吸功能受损风险相关的因素。本探索性试验的目的是研究在接受腰麻联合布比卡因/吗啡和芬太尼剖宫产（CS）的肥胖母亲术后第一晚的呼吸暂停/低通气指数。连续纳入年龄≥18岁、计划接受布比卡因/吗啡/芬太尼腰麻剖宫产的肥胖（BMI>30 kg/m²）母亲，术后第一晚使用便携式多导睡眠监测设备Embletta /NOX进行监测。通过临床算法确定呼吸暂停/低通气指数（AHI），并根据一般指南进行评估；每小时呼吸暂停/低通气发作次数：<5为“正常”，≥5且<15、≥15且<30、≥30。以类似方式计算每小时的氧饱和度下降事件作为氧饱和度下降指数（ODI）。邀请了40名母亲参与：27名同意，23名被纳入，但3名的多导睡眠图记录失败。在研究的20名母亲中：11名AHI<5（ ），7名母亲AHI≥5但<15（ ），2名母亲AHI≥15（ ），无AHI≥30者。ODI平均为4.4，8名患者ODI>5。AHI高的母亲（15.3和18.2）ODI并不高。平均血氧饱和度为94%（91 - 96%），4名母亲平均SpO 为90 - 94%，无平均SpO2<90%者。腰麻联合吗啡剖宫产术后一晚对中度肥胖母亲进行呼吸多导睡眠监测显示，从睡眠医学角度来看，AHI被认为是正常、轻度和中度的。阻塞性事件和血氧饱和度下降发作通常不同步。有必要进一步研究对肥胖母亲进行术前睡眠呼吸暂停筛查，但术后早期呼吸多导睡眠图记录繁琐且提供的重要信息稀少。
