多沙普伦对择期行减肥手术的年轻病态肥胖患者拔管时间及早期康复的影响：随机对照试验

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多沙普伦对择期行减肥手术的年轻病态肥胖患者拔管时间及早期康复的影响：随机对照试验

翻译：牛振瑛  编辑：冯玉蓉  审校：曹莹

背景：减肥手术是治疗肥胖的有效方法之一。减肥手术后呼吸衰竭和气道阻塞可归因于麻醉剂、镇静剂和阿片类药物的残余抑制作用。病态肥胖患者的围术期管理仍是手术室相关专业人员关注的问题。

目的：评估多沙普伦对病态肥胖者减肥手术后全身麻醉苏醒的效果。

设计：单盲随机平行对照试验。

机构：三级护理教学医院。

受试者：共100名二级以上肥胖的患者(69名女性)被平均分为两组并接受减肥手术。

主要结果测量：主要观察指标是从使用多沙普伦到拔出气管导管的时间。次要观察指标包括生命体征及其改变，如最大呼气流速、恢复自主呼吸的时间、睁眼和按指令握手的时间，以及全麻苏醒时间。

干预措施：两组患者均实施全身麻醉。干预组在神经肌肉阻滞作用逆转后和所有麻醉药停用后立即单次给予多沙普伦1 mg·kg^-1。

结果：多沙普伦显著缩短拔管时间、睁眼时间和按指令握手时间，缩短苏醒时间，降低呼气末二氧化碳分压(P均<0.001)。此外，多沙普伦能提高最大呼气峰流速、血氧饱和度、体温、心率和血压(P均<0.001)。两组患者的脑电双频指数和平均动脉压相似(P均>0.05)。所有受试者均未出现多沙普伦相关的不良反应。

结论：在接受减肥手术的病态肥胖患者中，术后应用多沙普伦可提高最大呼气流速，减少麻醉恢复期的呼吸道并发症。多沙普伦在年轻的ASA分级I级至II级的病态肥胖患者中耐受性良好；然而，麻醉医生应在使用多沙普伦后至少半小时内谨慎评估生命体征。

原始文献来源：Fathi M, Massoudi N, Nooraee N, et al. The effects of doxapram on time to tracheal extubation and early recovery in young morbidly obese patients scheduled for bariatric surgery[J]. Eur J Anaesthesiol 2020 Jun;37(6).DOI：10.1097/EJA.0000000000001144

The effects of doxapram on time to tracheal extubation and early recovery in young morbidly obese patients scheduled for bariatric surgery：A randomised controlled trial

Abstract

BACKGROUND  Bariatric surgery is a well established treatment of the obese. Postoperative respiratory failure and airway obstruction after bariatric surgery can often be attributed to the residual depressant effects of anaesthetics,sedatives and opioids. Peri-operative management of morbidly obese patients is still a concern for operating room professionals.

OBJECTIVE  The evaluation of the effects of doxapram on the outcomes of general anaesthesia following bariatric surgical procedures in the morbidly obese.

DESIGN  A single-blind randomised controlled trial with two parallel arms.

SETTING  A tertiary care teaching hospital, Tehran, Iran, from 2017 to 2018.

PARTICIPANTS  In total, 100 patients (69 women) with at least class two obesity were included in two groups of equal sizes and underwent bariatric surgery.

MAIN OUTCOME MEASURES  The primary outcome was the time from the administration of doxapram to tracheal extubation. Secondary outcomes included vital signs and variables including peak expiratory flow rate, time to return to spontaneous breathing, time to eye-opening and hand-squeezing on the commands, and time to recovery.

INTERVENTIONS  Both groups underwent general anaesthesia. The intervention group received a single dose of doxapram 1 mg kg^-1ideal body weight, immediately after reversal of neuromuscular blockade and after discontinuation of all anaesthetics.

RESULTS  Doxapram decreased time to extubation, time to eye-opening and hand-squeezing, shortened recovery time and lowered end-tidal CO2significantly (all P<0.001).Moreover, it increased peak expiratory flow rate, oxygen saturation, temperature, heart rate and blood pressure (all P<0.001). The two groups were similar in the bispectral index and mean arterial pressure (both P>0.05). None of our participants had complications attributable to doxapram.

CONCLUSION  The postoperative use of doxapram improves peak expiratory flow rate, and decreases respiratory complications of anaesthesia during recovery in the morbidly obese undergoing bariatric surgery. Doxapram is well tolerated in young ASA physical status classes 1 to 2 morbidly obese patients; however, the anaesthesiologist should cautiously evaluate the vital signs for at least half an hour following the administration of doxapram.

贵州医科大学高鸿教授课题组

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