布托啡诺对行胃肠镜检查患者内脏痛的影响：一项随机对照试验

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布托啡诺对行胃肠镜检查患者内脏痛的影响：一项随机对照试验

贵州医科大学  麻醉与心脏电生理课题组

翻译：邓举

编辑：宋雨婷

审校：曹莹

1、背景

布托啡诺对呼吸和循环系统影响轻微，对缓解机械性牵拉引起的不适有较好的效果，且术后恶心呕吐（PONV）发生率低。布托啡诺联合丙泊酚可抑制术后内脏痛，这一疼痛在胃肠道内镜检查中是可避免的。因此，我们推测布托啡诺可以降低胃镜检查和结肠镜检查患者术后内脏痛的发生率。

2、方法

这是一项随机、安慰剂对照、双盲试验。将接受胃肠道内镜检查的患者随机分为静脉注射布托啡诺组（I组）和生理盐水组（II组）。主要结局指标为进入麻醉后恢复室10 min后术后内脏痛的发生率。次要结局指标包括安全结局和不良事件的发生率。将视觉模拟量表（VAS）评分≥1定义为术后内脏痛。

3、结果

该试验共纳入206例患者。203例患者被随机分至I组（n=102）或II组（n=101）, 纳入194例患者数据进行分析：I组95例，II组99例。进入麻醉后恢复室10 min后，使用布托啡诺的患者内脏痛发生率低于使用安慰剂的患者（分别为31.5%比68.5%；RR:2.738, 95%CI[1.409–5.319]，P=0.002），两组疼痛水平或内脏痛（P=0.006）有显著差异。

4、结论

布托啡诺联合丙泊酚可降低胃肠道内镜检查患者术后内脏痛的发生率，且对循环和呼吸功能没有明显的影响。

原始文献来源：

Jing Wang, Xinyan Wang, Haiyang Liu,et al.Efect of butorphanol on visceral pain in patients undergoing gastrointestinal endoscopy: a randomized controlled trial［J］.BMC Anesthesiology (2023) 23:93.       

英文原文

Effect of butorphanol on visceral pain  in patients undergoing gastrointestinal  endoscopy: a randomized controlled trial

Background: Butorphanol slightly infuences the respiratory and circulatory systems, has a better efect on relieving the discomfort caused by mechanical traction, and has a low incidence of postoperative nausea and vomiting (PONV). Combined butorphanol and propofol may suppress postoperative visceral pain, which is avoidable in gastrointestinal endoscopy. Thus, we hypothesized that butorphanol could decrease the incidence of postoperative visceral pain in patients undergoing gastroscopy and colonoscopy.

Methods: This was a randomized, placebo-controlled, and double-blinded trial. Patients undergoing gastrointestinal endoscopy were randomized to intravenously receive either butorphanol (Group I) or normal saline (Group II). The primary outcome was visceral pain after the procedure 10 min after recovery. The secondary outcomes included the rate of safety outcomes and adverse events. Postoperative visceral pain was defned as a visual analog scale (VAS) score≥1.

Results: A total of 206 patients were enrolled in the trial. Ultimately, 203 patients were randomly assigned to Group I (n=102) or Group II (n=101). In total, 194 patients were included in the analysis: 95 in Group I and 99 in Group II. The incidence of visceral pain at 10 min after recovery was found to be statistically lower with butorphanol than with the placebo (31.5% vs. 68.5%, respectively; RR: 2.738, 95% CI [1.409–5.319], P=0.002), and the notable diference was in pain level or distribution of visceral pain (P=0.006).

Conclusions: The trial indicated that adding butorphanol to propofol results in a lower incidence of visceral pain after surgery without noticeable fuctuations in circulatory and respiratory functions for gastrointestinal endoscopy patients.

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