Effects of remifentanil on pharyngeal swallowing: A double blind randomised cross-over study in healthy volunteers
Effects of remifentanil on pharyngeal swallowing: A double blind randomised cross-over study in healthy volunteers
复制标题
瑞芬太尼对咽部吞咽的影响：健康志愿者的双盲随机交叉研究
DOI：
10.1097/eja.0000000000000461
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发表时间：
2016
影响因子：
3.6
通讯作者：
R. Ahlstrand
中科院分区：
文献类型：
--
作者：
J. Savilampi;T. Omari;A. Magnuson;R. Ahlstrand
背景技术接触瑞芬太尼会增加健康志愿者肺误吸的发生率。这种效应可以通过气道防御机制受损和/或吞咽功能改变来解释。压力流量分析是一种根据丸剂吞咽过程中记录的压力阻抗模式对吞咽进行客观评估的技术。目的 本研究的目的是使用压力流量分析来量化瑞芬太尼对健康咽部吞咽的影响，并将这些影响与吗啡进行比较。设计一项双盲、随机、交叉研究。设置 三级护理教学医院。志愿者 11 名年轻志愿者（平均年龄，23 岁）和 7 名老年志愿者（平均年龄，73 岁）。干预措施 志愿者接受了两次研究，并接受目标控制的瑞芬太尼输注（目标浓度：年轻，3 ng ml−1；老年，2 ng ml−1）或吗啡推注（剂量：年轻，0.1 mg kg−1；老年，0.07 mg kg−1）。在每个测量阶段吞咽 10 剂液体时，用留置导管记录咽部压力和阻抗。计算并比较定义吞咽功能的变量以确定药物作用。主要观察指标 瑞芬太尼暴露后的咽部压力-流量变量。结果 瑞芬太尼在测量变量中产生的变化与更大的吞咽功能障碍一致。咽部收缩和咽部推力的强度均降低，而流动阻力增加。吞咽风险指数（吞咽功能障碍的全球指数）总体上升。在测试的实验剂量下，吗啡对吞咽产生类似但不太广泛的影响。结论瑞芬太尼导致咽部吞咽机制功能障碍。这可能会增加误吸的风险。试验注册 NCT01924234 (www.clinicaltrials.gov)。
BACKGROUND Exposure to remifentanil increases the incidence of pulmonary aspiration in healthy volunteers. This effect may be explained by impairment of airway defence mechanisms and/or altered swallowing function. Pressure-flow analysis is a technique that allows objective assessment of swallowing based on pressure-impedance patterns recorded during bolus swallowing. OBJECTIVES The aim of this study was to use pressure-flow analysis to quantify the effect of remifentanil on healthy pharyngeal swallowing and to compare these effects with morphine. DESIGN A double-blind, randomised, cross-over study. SETTING A tertiary care teaching hospital. VOLUNTEERS Eleven young volunteers (mean age, 23 years) and seven older volunteers (mean age, 73 years). INTERVENTIONS Volunteers were studied twice and received either a target-controlled remifentanil infusion (target concentrations: young, 3 ng ml−1; old, 2 ng ml−1) or a bolus injection of morphine (dose: young, 0.1 mg kg−1; old, 0.07 mg kg−1). Pharyngeal pressure and impedance were recorded with an indwelling catheter while swallowing 10 boluses of liquid during each measuring phase. Variables defining swallowing function were calculated and compared to determine drug effects. MAIN OUTCOME MEASURES Pharyngeal pressure-flow variables following remifentanil exposure. RESULTS Changes produced by remifentanil in the measured variables were consistent with greater dysfunction of swallowing. Both the strength of the pharyngeal contractions and pharyngeal bolus propulsion were reduced, whereas flow resistance was increased. The swallow risk index, a global index of swallowing dysfunction, increased overall. At the experimental doses tested, morphine produced similar, but less extensive effects on swallowing. CONCLUSION Remifentanil induced dysfunction of the pharyngeal swallowing mechanism. This may contribute to an increased risk of aspiration. TRIAL REGISTRATION NCT01924234 (www.clinicaltrials.gov).