Sims C, Johnson C M
Department of Anaesthesia, Princess Margaret Hospital for Children, Subiaco, Western Australia.
Anaesth Intensive Care. 1994 Feb;22(1):40-5. doi: 10.1177/0310057X9402200108.
Past studies concerning postoperative apnoea in infants were identified and reviewed. A total of only 200 former preterm infants having minor surgery under general anaesthesia have been prospectively studied. The incidence of apnoea after general anaesthesia is approximately 30%, and is inversely related to postconceptual age. A large number of term infants have been studied, and the incidence of postoperative apnoea is very low. The initial apnoea is always within 12 hours of surgery, though only one study has collected data beyond this length of time. Past history of apnoea episodes, bronchopulmonary dysplasia, anaemia or neurological disease may be associated with an increased risk, though current evidence is not strong. No patient characteristic apart from postconceptual age has enough sensitivity and specificity to identify a high-risk group. The use of spinal anaesthesia or methylxanthines may reduce the incidence of postoperative apnoea, but again the evidence is not strong. Recommendations concerning the timing of elective surgery and the use of postoperative respiratory monitoring in the former preterm infant can only be made cautiously in view of the paucity of data on which to base them.
我们对过去有关婴儿术后呼吸暂停的研究进行了检索和综述。总共仅有200例曾为早产儿的婴儿接受了前瞻性研究，这些婴儿在全身麻醉下接受了小手术。全身麻醉后呼吸暂停的发生率约为30%，且与孕龄呈负相关。已有大量足月儿接受了研究，术后呼吸暂停的发生率很低。首次呼吸暂停总是发生在手术后12小时内，不过只有一项研究收集了超过这段时间的数据。呼吸暂停发作的既往史、支气管肺发育不良、贫血或神经系统疾病可能与风险增加有关，不过目前证据并不充分。除孕龄外，没有任何患者特征具有足够的敏感性和特异性来识别高危人群。使用脊髓麻醉或甲基黄嘌呤可能会降低术后呼吸暂停的发生率，但同样证据并不充分。鉴于可供参考的数据匮乏，对于择期手术的时机以及对曾为早产儿术后呼吸监测的应用，只能谨慎地提出建议。
