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

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（ χ² = 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（ χ² = 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（ χ² = 4.137、4.213，P = 0.042、0.040）。 结论与丙泊酚相比较，持续静脉输注布托啡诺可以减少ARF行NIV躁动患者芬太尼的需要量，并改善血流动力学状态。

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

ObjectiveTo compare sedative effects of butorphanol and propofol on restless patients with acute respiratory failure (ARF) undergoing noninvasive ventilation (NIV). MethodsTotally 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) Ⅱ score, 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. ResultsThere 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, χ² = 0.038, P = 0.845), while the use of fentanyl (4 / 57 vs. 49 / 61) and occurrence of adverse events (9 / 57 vs. 26 / 61) were statistically significantly different between the two groups ( χ² = 64.007, 10.169; P < 0.001, = 0.001). Moreover, the occurrence of hypotension (2 / 57 vs. 16 / 61) and hypovolemia (1 / 57 vs. 13 / 61) were statistically significantly different between these two groups ( χ² = 4.137, 4.213; P = 0.042, 0.040). ConclusionCompared with propofol, continuous intravenous infusion of butorphanol can reduce fentanyl amount and improve hemodynamic status in restless patients with ARF undergoing NIV.