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

doi:10.3877/cma.j.issn.1674-6880.2020.03.006

Abstract

Abstract:

Objective

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) 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.

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, 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).

Conclusion

Compared with propofol, continuous intravenous infusion of butorphanol can reduce fentanyl amount and improve hemodynamic status in restless patients with ARF undergoing NIV.

Key words: Acute respiratory failure, Noninvasive ventilation, Butorphanol, Propofol

Mahong Hu, Jianbiao Meng, Yanna Jiao, Zhizhen Lai, Mei Liu, Lisha Pang, Minrong Xu, Wei Zhang, Tiejun Wang, Geng Zhang. Comparative study on sedative effects of butorphanol and propofol on restless patients with acute respiratory failure undergoing noninvasive ventilation[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2020, 13(03): 188-194.

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References 27

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组别	例数	年龄（岁）	性别比（例，男/女）	APACHEⅡ评分（分）	SOFA评分（分）	引起ARF的原因[例（%）]
组别	例数	年龄（岁）	性别比（例，男/女）	APACHEⅡ评分（分）	SOFA评分（分）	肺炎	AECOPD	支气管哮喘	心力衰竭	其他
布托啡诺组	57	62 ± 16	33 / 24	14 ± 4	4.2 ± 1.7	34（59.6）	12（21.1）	3（5.3）	5（8.8）	3（5.3）
丙泊酚组	61	58 ± 18	39 / 22	15 ± 4	4.4 ± 1.6	38（62.3）	10（16.4）	5（8.2）	4（6.6）	4（6.6）
t / χ²值	?	1.259	0.452	1.039	0.658	1.024
P值	?	0.211	0.501	0.301	0.512	0.906

组别	例数	年龄（岁）	性别比（例，男/女）	APACHEⅡ评分（分）	SOFA评分（分）	引起ARF的原因[例（%）]
组别	例数	年龄（岁）	性别比（例，男/女）	APACHEⅡ评分（分）	SOFA评分（分）	肺炎	AECOPD	支气管哮喘	心力衰竭	其他
布托啡诺组	57	62 ± 16	33 / 24	14 ± 4	4.2 ± 1.7	34（59.6）	12（21.1）	3（5.3）	5（8.8）	3（5.3）
丙泊酚组	61	58 ± 18	39 / 22	15 ± 4	4.4 ± 1.6	38（62.3）	10（16.4）	5（8.2）	4（6.6）	4（6.6）
t / χ²值	?	1.259	0.452	1.039	0.658	1.024
P值	?	0.211	0.501	0.301	0.512	0.906

组别	例数	NIV不耐受评分		SAS评分		VAS评分
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
布托啡诺组	57	2.6 ± 0.8	1.2 ± 0.5^a	5.5 ± 0.9	3.5 ± 0.4^a	6.4 ± 1.2	1.8 ± 0.3^a
丙泊酚组	61	2.7 ± 1.1	1.3 ± 0.7^a	5.3 ± 0.8	3.6 ± 0.5^a	6.6 ± 1.3	1.7 ± 0.3^a
t值	?	0.561	0.887	1.278	1.194	0.867	1.809
P值	?	0.576	0.377	0.204	0.235	0.388	0.072

组别	例数	NIV不耐受评分		SAS评分		VAS评分
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
布托啡诺组	57	2.6 ± 0.8	1.2 ± 0.5^a	5.5 ± 0.9	3.5 ± 0.4^a	6.4 ± 1.2	1.8 ± 0.3^a
丙泊酚组	61	2.7 ± 1.1	1.3 ± 0.7^a	5.3 ± 0.8	3.6 ± 0.5^a	6.6 ± 1.3	1.7 ± 0.3^a
t值	?	0.561	0.887	1.278	1.194	0.867	1.809
P值	?	0.576	0.377	0.204	0.235	0.388	0.072

组别	例数	呼吸频率（次/ min）		pH值		FiO₂
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
布托啡诺组	57	30.3 ± 6.1	20.1 ± 6.4^a	7.29 ± 0.08	7.41 ± 0.06^a	0.72 ± 0.26	0.40 ± 0.12^a
丙泊酚组	61	29.5 ± 6.3	21.3 ± 4.4^a	7.30 ± 0.10	7.40 ± 0.06^a	0.69 ± 0.22	0.42 ± 0.11^a
t值	?	0.700	1.194	0.602	0.905	0.678	0.945
P值	?	0.485	0.235	0.449	0.367	0.499	0.347
组别	例数	PaO₂（mmHg）		PaO₂ / FiO₂（mmHg）		PaCO₂（mmHg）
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
布托啡诺组	57	92 ± 44	97 ± 40	196 ± 44	290 ± 48^a	50 ± 6	34 ± 8^a
丙泊酚组	61	96 ± 38	95 ± 40	202 ± 55	282 ± 51^a	48 ± 6	35 ± 7^a
t值	?	0.519	0.311	0.660	0.808	1.624	0.836
P值	?	0.604	0.756	0.511	0.421	0.107	0.405

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