布托啡诺与丙泊酚对急性呼吸衰竭行无创机械通气躁动患者镇静作用的比较研究  

Comparative study on sedative effects of butorphanol and propofol on restless patients with acute respiratory failure undergoing noninvasive ventilation

作　　者：胡马洪[1] 孟建标[1] 焦燕娜[2] 赖志珍[1] 刘梅 庞丽莎 徐敏荣 张微[1] 王铁钧[1] 张庚[1] Hu Mahong;Meng Jianbiao;Jiao Yanna;Lai Zhizhen;Liu Mei;Pang Lisha;Xu Minrong;Zhang Wei;Wang Tiejun;Zhang Geng(Department of Intensive Care Unit,Tongde Hospital of Zhejiang Province,Hangzhou 310012,China;Department of Intensive Care Unit,the First Affiliated Hospital,College of Medicine,Zhejiang University,Hangzhou 310003,China)

机构地区：[1]浙江省立同德医院重症医学科,杭州310012 [2]浙江大学医学院附属第一医院重症医学科,杭州310003

出　　处：《中华危重症医学杂志（电子版）》2020年第3期188-194,共7页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：浙江省基础公益研究计划项目(LGF18H150010)。

摘　　要：目的比较布托啡诺与丙泊酚干预急性呼吸衰竭(ARF)行无创机械通气(NIV)躁动患者的镇静作用情况。方法将118例ARF行NIV治疗的躁动患者分为布托啡诺组(57例)及丙泊酚组(61例),两组患者分别予以输注布托啡诺和丙泊酚,维持镇静躁动评分(SAS)于3~4分,在治疗过程中根据需要给予咪达唑仑及芬太尼治疗。记录两组患者的一般资料,治疗前及治疗24 h后急性病生理学和长期健康评价(APACHE)Ⅱ评分、序贯器官衰竭估计(SOFA)评分、NIV不耐受评分、SAS评分、视觉模拟评分法(VAS)、呼吸频率、pH值、吸入氧浓度(FiO2)、动脉血氧分压(PaO2)、PaO2/FiO2、动脉血二氧化碳分压(PaCO2),咪达唑仑和芬太尼使用情况及不良事件发生情况。结果布托啡诺组和丙泊酚组患者治疗后NIV不耐受评分[(1.2±0.5)分vs.(1.3±0.7)分]、SAS评分[(3.5±0.4)分vs.(3.6±0.5)分]、VAS评分[(1.8±0.3)分vs.(1.7±0.3)分]、呼吸频率[(20.1±6.4)次/min vs.(21.3±4.4)次/min]、pH值[(7.41±0.06)vs.(7.40±0.06)]、FiO2[(0.40±0.12)vs.(0.42±0.11)]、PaO2[(97±40)mmHg vs.(95±40)mmHg]、PaO2/FiO2[(290±48)mmHg vs.(282±51)mmHg]及PaCO2[(34±8)mmHg vs.(35±7)mmHg]比较,差异均无统计学意义(t=0.887、1.194、1.809、1.194、0.905、0.945、0.311、0.808、0.836,P=0.377、0.235、0.072、0.235、0.367、0.347、0.756、0.421、0.405)。两组患者治疗后NIV不耐受评分、SAS评分、VAS评分、呼吸频率、FiO2和PaCO2水平较同组治疗前均显著降低,而pH值及PaO2/FiO2较同组治疗前均显著升高(P均<0.05)。布托啡诺组和丙泊酚组患者咪达唑仑使用情况(44/57 vs.48/61)比较,差异无统计学意义(χ^2=0.038,P=0.845);而芬太尼使用情况(4/57 vs.49/61)及不良事件发生情况(9/57 vs.26/61)比较,差异均有统计学意义(χ^2=64.007、10.169,P<0.001、=0.001)。其中,两组患者的低血压(2/57 vs.16/61)及低血容量(1/57 vs.13/61)的发生情况比较,差异均有统计学意义(χ^2=4.137、4.213,P=0.042、0Objective To compare sedative effects of butorphanol and propofol on restless patients with acute respiratory failure(ARF)undergoing noninvasive ventilation(NIV).Methods Totally 118 restless ARF patients treated with NIV were divided into a butorphanol group(57 cases)and a propofol group(61 cases).Patients in these two groups were respectively treated with butorphanol and propofol to maintain the sedation agitation score(SAS)of 3-4 scores,and midazolam and fentanyl were given as needed during treatment.The general data,acute physiology and chronic health evaluation(APACHE)Ⅱscore,sequential organ failure assessment(SOFA)score,NIV intolerance score,SAS,visual analogue scale(VAS),respiratory rate,pH value,fraction of inspiratory oxygen(FiO2),arterial partial pressure of oxygen(PaO2),PaO2/FiO2 and arterial partial pressure of carbon dioxide(PaCO2)before and 24 h after treatment,use of midazolam and fentanyl,and occurrence of adverse events of patients were recorded in both groups.Results There were no significant differences in NIV intolerance scores[(1.2±0.5)scores vs.(1.3±0.7)scores],SAS[(3.5±0.4)scores vs.(3.6±0.5)scores],VAS[(1.8±0.3)scores vs.(1.7±0.3)scores],respiratory rate[(20.1±6.4)breaths/min vs.(21.3±4.4)breaths/min],pH values[(7.41±0.06)vs.(7.40±0.06)],FiO2[(0.40±0.12)vs.(0.42±0.11)],PaO2[(97±40)mmHg vs.(95±40)mmHg],PaO2/FiO2[(290±48)mmHg vs.(282±51)mmHg],and PaCO2[(34±8)mmHg vs.(35±7)mmHg]between the butorphanol group and the propofol group after treatment(t=0.887,1.194,1.809,1.194,0.905,0.945,0.311,0.808,0.836;P=0.377,0.235,0.072,0.235,0.367,0.347,0.756,0.421,0.405).The NIV intolerance score,SAS,VAS,respiratory rate,FiO2 and PaCO2 levels of these two groups were significantly lower after treatment than before treatment,and the pH value and PaO2/FiO2 level were significantly higher after treatment than before treatment(all P<0.05).There was also no significant difference in the use of midazolam()between these two groups(44/57 vs.48/61,χ^2=0.038,P=0.845),while the use of fentanyl(4/57

关 键 词：急性呼吸衰竭 无创机械通气 布托啡诺 丙泊酚 

分 类 号：R614[医药卫生—麻醉学]