Study Of Butorphanol In Mechanically Ventilated Patients And The Analysis Of Risk Factors For Respiratory Depression Events In Non-mechanically Ventilated Patients

Chapter One:Introduction:Overview of the status of pain in severe patients and the mechanism and clinical research progress of commonly used opioid-related respiratory depressionPain is one of the most common symptoms in patients in the intensive care unit,and severe pain often leads to a poor prognosis.Classical opioids cause analgesic effects by activating central nervous system opioid receptors,but they also cause adverse reactions.Respiratory depression caused by opioids can be fatal,so the development of new opioid analgesics is urgently needed to reduce the respiratory depression caused by opioids.Chapter Two:A prospective,randomized study comparing fentanyl,butorphanol with fentanyl alternate butorphanol in mechanically ventilated postoperative patientsObjective:To compare the quality of sedation and analgesia,dosage,duration of mechanical ventilation(MV)and side-effects provided by a fentanyl/butorphanol-based analgesia regime with that provided by a traditional fentanyl-based or butorphanol-based regime in mechanically ventilated postoperative patients.Methods:This was a prospective study involving(n=107)adult postoperative patients requiring MV for more than 24 h.Patients were randomized to a fentanyl/butorphanol infusion(n=32)or a fentanyl infusion(n=35)or a butorphanol infusion(n=40)by randomly number table method.General data,mean arterial pressure(MAP),Heart rate(HR),spontaneous respiration rate(RRs),cumulative dosage of analgesics and sedatives,time on MV,time of weaning and extubation,side-effects were recorded.Results:There was no statistically significant difference in CPOT and SAS score at same time among three groups.Compared with the fentanyl group,the MAP(mmHg:75.6±6.1 vs 67.0±8.4,P<0.05)and RRs(times/min:7.6±3.4 vs 5.1±2.2,P<0.05)at 30min after treatment in butorphanol group were significantly increased;cumulative dosage of propofol in fentanyl/butorphanol group were significantly decreased(g:2.1 ±0.2 vs 2.5±0.3,P<0.05),and duration of MV had a decreased tendency(h:35.3±6.1 vs 42.4± 10.5,P=0.07),and time of weaning and extubation was significantly decreased in patients MV over three days(min:40.4±8.5 vs 55.4±16.4,P<0.05).Compared with the butorphanol group,time of weaning and extubation was significantly decreased in fentanyl/butorphanol group(min:40.4±8.5 vs 59.3±14.2,P<0.05).Conclusions:Patients in fentanyl alternate butorphanol-based analgesia protocol achieved satisfactory pain control.Compared with fentanyl group,butorphanol group,a fentanyl/butorphanol-based regimen for analgesia and sedation supplemented with propofol significantly reduced the time on mechanical ventilation and time of weaning and extubation.Chapter Three:The analysis of risk factors for respiratory depression events in non-mechanically ventilated patientsObjective:To investigate the status of respiratory depression events in patients with non-mechanically ventilation who received opioids analgesia.Analysis of possible predictors of respiratory depression events in non-mechanical ventilation patients in ICU.Provide clinical data for the application of opioid analgesics in patients with non-mechanically ventilation.Methods:During the period from June 1,2019 to September 31,2019,103 patients with non-mechanical ventilation(including weaned from mechanical ventilation)for more than 24 hours in the Department of Intensive Medicine was included.Clinical data such as general information,respiratory depression events were recorded.After preprocessing,the data are described by the number of cases and percentages.Statistical analysis was performed by R software.The least absolute shrinkage and selection operator regression model(Lasso)was used to optimize feature selection.Multivariable logistic regression analysis was applied to build a predicting model incorporating the feature selected in the least absolute shrinkage and selection operator regression model.Then,establishing the non-MV patients’respitatory depression events nomogram of this risk model.Discrimination,calibration of the predicting model was assessed using the C-index,calibration plot.Internal validation was assessed using the bootstrapping validation.Results:Respiratory depression events was diagnosed in 49(47.6%)of 103 patients.Predictors contained in the prediction nomogram included disease categories(OR=5.569,95%CI=0.751～118.083;OR=32.833,95%CI=4.189～725.164),sepsis(OR=6.898,95%CI=1.756～33.000),duration of mechanical ventilation(OR=3.019,95%CI=0.862～11.322;OR=20.757,95%CI=2.409～502.222)and oxygenation index(OR=7.350,95%CI=2.483～24.286).The line which represents the performance of the nomogram fits well with the line that represents a good prediction by an ideal model.Conclusions:This non-MV patients’ respitatory depression events nomogram incorporating disease categories,sepsis,duration of mechanical ventilation and OI displayed good discrimination,good calibration.It provided some clues for the management of respiratory depression events in non-MV patients in ICU.