手術後使用並換自控式類鴉片止痛劑所引發之急性呼吸抑制

Acute Respiratory Depression Associated with Postoperative Patient-Controlled Opioid Analgesia

廖伯武(Po-Wu Liao) ； 陳文彬(Wen-Pin Chen) ； 陳正文(Jeng-Wen Chen) ； 詹益智(Yi-Chih Chan) ； 林昭傑(Chao-Chieh Lin)

《輔仁醫學期刊》 2卷3期 (2004/09) Pp. 209-212

摘要

使用經靜脈注射含嗎啡(morphine)之病患自控式止痛(patient-controlled analgesia, PCA)裝置，有逐年增加的趨勢。本報告為一名50歲的女性病患，因長期打鼾及阻塞性睡眠呼吸中止症(obstructive sleep apnea syndrome)於2003年7月在本院接受懸雍垂顎咽成型術(uvulopalatopharyngoplasty)後，病人要求麻醉科醫師裝置經靜脈注射含嗎啡之病患自控式止痛裝置。病人於返回病房一小時後，發生急性呼吸抑制；經緊急復甦術後病人回復自主呼吸，於門診追蹤至今6個月無任何後遺症。本報告提醒在阻塞性睡眠呼吸中止症術後，即使嗎啡的劑量在安全範圍內，仍能引發急性呼吸抑制(acute respiratory depression)，並討論其預防方法。

關鍵字

嗎啡 ； 病患自控式止痛 ； 阻塞性睡眠呼吸中止症 ； 懸雍垂顎咽成型術 ； 急性呼吸抑制

並列摘要

Patient-controlled intravenous delivery of morphine for postoperative pain management is constantly increasing. However, side effects such as constipation, nausea, vomiting, urinary retention, sedation, postural hypotension, respiratory depression, and addiction are occasionally seen. We report on a 50-year-old woman who received uvulopalatopharyngoplasty (UPPP) due to obstructive sleep apnea syndrome (OSAS) in July 2003. She asked for patient-controlled analgesia in the recovery room after waking up from general anesthesia. Acute respiratory depression occurred 1 hour after returning to the ward. Spontaneous respiration was regained after immediate resuscitation, and no complications were noticed over the 6-month follow-up period. PCA-related acute respiratory depression after UPPP in OSAS patients may occur even if the dosage of morphine used is within the safe range.

並列關鍵字

morphine ； patient-controlled analgesia ； obstructive sleep apnea syndrome ； uvulopalatopharyngoplasty ； acute respiratory depression