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中华重症医学电子杂志 ›› 2019, Vol. 05 ›› Issue (03) : 235 -238. doi: 10.3877/cma.j.issn.2096-1537.2019.03.006

所属专题: 镇痛镇静 文献

临床研究

布托啡诺联合右美托咪定对创伤性颅脑损伤患者镇痛效果的评价
潘小东1, 邢超2, 汤鲁明1, 孙来芳1,()   
  1. 1. 325000 温州,温州医科大学附属第二医院急诊科
    2. 325000 温州,温州医科大学附属第二医院检验科
  • 收稿日期:2019-03-07 出版日期:2019-08-28
  • 通信作者: 孙来芳
  • 基金资助:
    浙江省自然科学基金(LY17H200002)

Analgesic effect of Butorphanol combined with Dexmedetomidine in patients with traumatic brain injury

Xiaodong Pan1, Chao Xing2, Luming Tang1, Laifang Sun1,()   

  1. 1. Department of Emergency, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
    2. Department of Clinical Laboratory, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
  • Received:2019-03-07 Published:2019-08-28
  • Corresponding author: Laifang Sun
  • About author:
    Corresponding author: Sun Laifang, Email:
引用本文:

潘小东, 邢超, 汤鲁明, 孙来芳. 布托啡诺联合右美托咪定对创伤性颅脑损伤患者镇痛效果的评价[J/OL]. 中华重症医学电子杂志, 2019, 05(03): 235-238.

Xiaodong Pan, Chao Xing, Luming Tang, Laifang Sun. Analgesic effect of Butorphanol combined with Dexmedetomidine in patients with traumatic brain injury[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2019, 05(03): 235-238.

目的

观察布托啡诺联合右美托咪定对创伤性颅脑损伤(TBI)患者的镇痛效果,为临床治疗提供依据。

方法

2018年1至5月在温州医科大学附属第二医院急诊ICU(EICU)收治的TBI患者60例,按随机数字表法分成2组,每组30例。布托啡诺组患者给予布托啡诺联合右美托咪定镇痛镇静,芬太尼组患者给予芬太尼联合右美托咪定治疗。收集并分析2组患者急性生理与慢性健康评分、格拉斯哥昏迷评分等临床指标。

结果

经治疗,布托啡诺组患者的心率、呼吸频率、重症监护疼痛观察量表疼痛评分及发生营养液潴留比例较芬太尼组均降低,差异均有统计学意义[(85.51±9.41)次/min vs (114.63±12.23)次/min,(23.41±3.92)次/min vs (33.87±5.12)次/min,(0.91±0.34)分 vs (2.11±0.39)分,10.0% vs 36.7%,均P<0.05],氧分压升高[(96.21±10.51)mmHg vs (74.18±8.54)mmHg,P<0.05],其他指标无明显差异。

结论

布托啡诺联系右美托咪定应用于ICU TBI患者有良好的镇痛效果,并发症较少。

Objective

To observe the analgesic effect of Butorphanol combined with Dexmedetomidine in patients with traumatic brain injury (TBI), providing evidence for clinical treatment of TBI.

Methods

60 Patients with TBI admitted to the EICU between January 2018 and May 2018 were included and divided into two groups, the Butorphanol group (30 cases) and the Fentanyl group (30 cases), with a random number table. Patients in the Butorphanol group were treated with Butorphanol plus Dexmedetomidine and those in the Fentanyl group were treated with Fentanyl plus Dexmedetomidine for analgesia and sedation. Clinical indicators including APACHEⅡand GCS scores were recorded and comparatively analyzed for the two groups.

Results

After treatment, the heart rate, respiration frequency, pain scores and the rate of nutrient retention of the patients in the Butorphanol group were lower than those of the Fentanyl group [(85.51±9.41) times/min vs (114.63±12.23) times/min, (23.41±3.92) times/min vs (33.87±5.12) times/min, (0.91±0.34) scores vs (2.11±0.39) scores, 10.0% vs 36.7%, all P<0.05], and the oxygen pressure was higher than that of the Fentanyl group [(96.21±10.51) mmHg vs (74.18±8.54) mmHg, P<0. 05]. No significant differences in other indicators were observed between the two groups.

Conclusion

Butorphanol combined with Dexmedetomidine is effective in patients with TBI in ICU with favorable analgesic effect and few complications.

表1 布托啡诺组与芬太尼组一般情况统计(±s
表2 布托啡诺组与芬太尼组临床指标比较(±s
表3 布托啡诺组与芬太尼组终点指标比较
表4 布托啡诺组与芬太尼组并发症发生情况比较[例(%)]
1
Patel SB, Kress JP. Sedation and analgesia in the mechanically ventilated patient [J]. Am J Respir Crit Care Med, 2012, 185(5): 486-497.
2
Payen JF, Chanques G, Mantz J, et al. Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study [J]. Anesthesiology, 2007, 106(4): 687-695.
3
Arora RS, Kulkarni KP, Alston RD. A survey of procedural sedation and analgesia practices in pediatric oncology centers in India [J]. Indian J Pediatr, 2012, 79(12): 1610-1616.
4
Taylor CA, Bell JM, Breiding MJ, et al. Traumatic brain injury-related emergency department visits, hospitalizations, and deaths-United States, 2007 and 2013 [J]. MMWR Surveill Summ, 2017, 66(9): 1-16.
5
Li J, Jiang JY. Chinese head trauma data bank: effect of hyperthermia on the outcome of acute head trauma patients [J]. J Neurotrauma, 2012, 29(1): 96-100.
6
Reintam BA, Malbrain ML, Starkopf J, et al. Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on abdominal problems [J]. Intensive Care Med, 2012, 38(3): 384-394.
7
Pain terms: a list with definitions and notes on usage. Recommended by the IASP Subcommittee on Taxonomy [J]. Pain, 1979, 6(3): 249.
8
中华医学会重症医学分会. 中国成人ICU镇痛和镇静治疗指南 [J/OL]. 中华重症医学电子杂志, 2018, 4(2): 90-113.
9
Erstad BL, Puntillo K, Gilbert HC, et al. Pain management principles in the critically ill [J]. Chest, 2009, 135(4): 1075-1086.
10
Richman PS, Baram D, Varela M, et al. Sedation during mechanical ventilation: a trial of benzodiazepine and opiate in combination [J]. Crit Care Med, 2006, 34(5): 1395-1401.
11
Rozendaal FW, Spronk PE, Snellen FF, et al. Remifentanil-propofol analgo-sedation shortens duration of ventilation and length of ICU stay compared to a conventional regimen: A centre randomised, cross-over, open-label study in the Netherlands [J]. Intensive Care Med, 2009, 35(2): 291-298.
12
徐静媛,杨毅. 镇痛镇静的终极目的:为何且如何实现器官保护? [J/OL]. 中华重症医学电子杂志, 2018, 4(3): 223-225.
13
王翠婷,杨翃. 颅脑损伤患者镇痛镇静治疗的临床应用进展 [J/OL]. 中华重症医学电子杂志, 2017, 3(4): 296-300.
14
庄心良,曾因明,陈伯銮. 现代麻醉学 [M]. 3版. 北京: 人民卫生出版社, 2003: 527-528.
15
Ishizuka T, Itami T, Tamura J, et al. Anesthetic and cardiorespiratory effects of propofol, medetomidine, lidocaine and Butorphanoltotal intravenous anesthesia in horses [J]. J Vet Med Sci, 2013, 75(2): 165-172.
16
Hawley P. Case report of severe bradycardia due to transdermal Fentanyl [J]. Palliat Med, 2013, 27(8): 793-795.
17
黄宇光,黄起文,李刚, 等. 酒石酸布托啡诺镇痛专家共识 [J]. 临床麻醉学杂志, 2011, 10(27): 1028-1029.
18
Commiskey S, Fan LW, Ho IK, et al. Butorphanol: effects of a prototypical agonist-antagonist analgesic on kappa-opioid receptors [J]. J Pharmacol Sci, 2005, 98(2): 109-116.
19
Henderson F, May WJ, Gruber RB, et al. Role of central and peripheral opiate receptors in the effects of Fentanyl on analgesia, ventilation and arterial blood-gas chemistry in conscious rats [J]. Respir Physiol Neurobiol, 2014, 191: 95-105.
20
Viscusi ER. Patient-controlled drug delivery for acute postoperative pain management: a review of current and emerging technologies [J]. Reg Anesth Pain Med, 2008, 33(2): 146-158.
21
Añez Simón C, Rull Bartomeu M, Rodríguez Pérez A, et al. Intranasal opioids for acute pain [J]. Rev Esp Anestesiol Reanim, 2006, 53(10): 643-652.
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