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

doi:10.3877/cma.j.issn.2096-1537.2019.03.006

Abstract

Abstract:

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.

Key words: Butorphanol, Dexmedetomidine, TBI, Analgesic

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

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2019.03.006

https://icu.cma-cmc.com.cn/EN/Y2019/V05/I03/235

Figures/Tables 4

References 21

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.

组别	例数	年龄（岁）	APACHEⅡ评分	GCS评分	血白蛋白（g/L）
布托啡诺组	30	60.6±12.3	19.5±4.4	6.1±1.8	31.6±5.1
芬太尼组	30	58.4±15.1	20.6±5.9	5.8±1.9	30.5±6.9
t值	?	1.05	-0.62	1.71	0.88
P值	?	0.54	0.68	0.71	0.24

组别	例数	年龄（岁）	APACHEⅡ评分	GCS评分	血白蛋白（g/L）
布托啡诺组	30	60.6±12.3	19.5±4.4	6.1±1.8	31.6±5.1
芬太尼组	30	58.4±15.1	20.6±5.9	5.8±1.9	30.5±6.9
t值	?	1.05	-0.62	1.71	0.88
P值	?	0.54	0.68	0.71	0.24

组别	例数	时间	HR（次/min）	RR（次/min）	MAP（mmHg）	PaO₂（mmHg）	PaCO₂（mmHg）	CPOT评分（分）
布托啡诺组	30	治疗前	127.34±10.37	36.21±2.81	110.52±10.42	57.62±8.35	42.69±3.28	3.33±0.75
布托啡诺组	30	治疗后	85.51±9.41^ab	23.41±3.92^ab	90.35±12.19^a	96.21±10.51^ab	43.08±5.71	0.91±0.34^ab
芬太尼组	30	治疗前	122.14±11.12	36.09±5.19	113.54±11.84	58.42±8.55	44.71±6.14	3.18±0.66
芬太尼组	30	治疗后	114.63±12.23	33.87±5.12	95.35±12.32^a	74.18±8.54^a	42.71±4.12	2.11±0.39

组别	例数	时间	HR（次/min）	RR（次/min）	MAP（mmHg）	PaO₂（mmHg）	PaCO₂（mmHg）	CPOT评分（分）
布托啡诺组	30	治疗前	127.34±10.37	36.21±2.81	110.52±10.42	57.62±8.35	42.69±3.28	3.33±0.75
布托啡诺组	30	治疗后	85.51±9.41^ab	23.41±3.92^ab	90.35±12.19^a	96.21±10.51^ab	43.08±5.71	0.91±0.34^ab
芬太尼组	30	治疗前	122.14±11.12	36.09±5.19	113.54±11.84	58.42±8.55	44.71±6.14	3.18±0.66
芬太尼组	30	治疗后	114.63±12.23	33.87±5.12	95.35±12.32^a	74.18±8.54^a	42.71±4.12	2.11±0.39

组别	例数	机械通气时间（d，±s）	住ICU时间（d，±s）	总住院时间（d，±s）	病死情况［例（%）］
布托啡诺组	30	11.4±5.3	19.2±3.1	37.0±16.2	7（23.3）
芬太尼组	30	10.9±4.5	20.7±2.6	35.7±10.1	10（33.3）
统计值	?	t=1.10	t=-0.82	t=1.24	χ²=-0.57
P值	?	0.35	0.44	0.21	0.52

Please choose a citation manager

Content to export