Shiota Takashi, Kawanishi Hideaki, Inoue Satoki, Egawa Junji, Kawaguchi Masahiko
Department of Anesthesiology and Division of Intensive Care, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
JA Clin Rep. 2018 Jun 13;4(1):46. doi: 10.1186/s40981-018-0186-x.
The use of both pulse oximetry (SpO) and respiration rate (RR) monitoring is recommended to prevent the development of respiratory deterioration, particularly after extubation and narcotic analgesic use for pain management. In this study, we investigated the factors contributing to the development of bradypnea in surgical patients receiving fentanyl-based intravenous analgesia after general anesthesia.
This study involved a historical chart review of postoperative patients outside an intensive care unit setting. We divided the patients according to the data collected during the first hour postoperatively, into those developing bradypnea (RR < 8 breaths per min for > 2 min) and those with normal RR under oxygen administration. We defined oxygen desaturation as SpO < 90% for > 10 s. We calculated the effect-site concentrations for fentanyl at the end of surgery and 1 h postoperatively using custom-made software based on chart records. A multivariable analysis was used to determine bradypnea-associated explanatory factors.
For the final analysis, we included 258 patients. We detected bradypnea in 125 patients (48%) and oxygen desaturation in 46 patients (18%). We found no difference in the effect-site fentanyl concentrations between patients with and without bradypnea. The logistic regression model revealed that liver dysfunction [odds ratio (OR), 2.918; 95% confidence interval (CI), 1.329-6.405], renal dysfunction (OR, 0.349; 95% CI, 0.128-0.955), and smoking history (OR, 0.236; 95% CI, 0.075-0.735) were independently associated with bradypnea. We found similar incidences of oxygen desaturation between the groups.
Bradypnea was observed in 48% of postoperative patients receiving fentanyl-based intravenous analgesia under oxygen therapy. According to our results, impaired liver function associated positively, whereas smoking history associated negatively with its development. Renal dysfunction was paradoxically associated with less incidence of bradypnea.
建议同时使用脉搏血氧饱和度（SpO）和呼吸频率（RR）监测，以预防呼吸功能恶化，尤其是在拔管后以及使用麻醉性镇痛药进行疼痛管理后。在本研究中，我们调查了全身麻醉后接受芬太尼静脉镇痛的外科患者发生呼吸过缓的相关因素。
本研究涉及对重症监护病房以外的术后患者进行历史病历回顾。我们根据术后第一小时收集的数据，将患者分为发生呼吸过缓（RR<8次/分钟，持续>2分钟）的患者和吸氧时RR正常的患者。我们将氧饱和度降低定义为SpO<90%，持续>10秒。我们使用基于病历记录的定制软件计算手术结束时和术后1小时芬太尼的效应室浓度。采用多变量分析确定与呼吸过缓相关的解释因素。
最终分析纳入258例患者。我们在125例患者（48%）中检测到呼吸过缓，在46例患者（18%）中检测到氧饱和度降低。我们发现有呼吸过缓和无呼吸过缓的患者之间效应室芬太尼浓度没有差异。逻辑回归模型显示，肝功能不全[比值比（OR），2.918；95%置信区间（CI），1.329 - 6.405]、肾功能不全（OR，0.349；95%CI，0.128 - 0.955）和吸烟史（OR，0.236；95%CI，0.075 - 0.735）与呼吸过缓独立相关。我们发现两组之间氧饱和度降低的发生率相似。
在接受芬太尼静脉镇痛的术后患者中，48%的患者在吸氧治疗时出现呼吸过缓。根据我们研究结果，肝功能受损与之呈正相关，而吸烟史与之呈负相关。肾功能不全与呼吸过缓发生率较低存在矛盾关联。
