Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China.
Department of Anesthesiology, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
Obes Surg. 2020 Oct;30(10):3919-3929. doi: 10.1007/s11695-020-04755-2.
Obesity is a risk factor for postoperative pulmonary complications (PPCs). Recent studies have reported the pulmonary protective role of the kappa opioid receptor (KOR). Butorphanol is a narcotic with strong KOR agonist action, and the role in pulmonary protection is uncertain. Here, we hypothesized that butorphanol exerts protective effects on pulmonary function in patients with obesity undergoing laparoscopic bariatric surgery.
Patients with a body mass index ≥ 30 kg/m scheduled for laparoscopic bariatric surgery were randomized to receive butorphanol or normal saline. Butorphanol was administered as an initial loading dose of 10 μg/kg at 5 min before induction followed by 5 μg/(kg h) during surgery. The primary outcome was arterial-alveolar oxygen tension ratio (a/A ratio). Secondary outcomes included other pulmonary variables, biomarkers reflecting pulmonary injury, and incidence of PPCs within 7 days after surgery.
Patients in the butorphanol group had a significantly higher a/A ratio at 1 h after the operation began (68 ± 7 vs. 55 ± 8, P < 0.001), end of the operation (73 ± 8 vs. 59 ± 7, P < 0.001), and 1 h after extubation (83 ± 9 vs. 70 ± 5, P < 0.001) compared with those in the control group. In addition, in the butorphanol group, dead space to tidal volume ratios were significantly lower than those in the control group at the same time points (all P < 0.001). In the control group, the levels of biomarkers reflecting pulmonary injury were significantly higher than those in the butorphanol group at 3 h, 6 h, 12 h, and 24 h postoperatively (P < 0.001). The incidence of PPCs was similar in both groups.
Butorphanol administration protected pulmonary function by improving oxygenation and reducing dead space ventilation in patients with obesity undergoing laparoscopic bariatric surgery. Butorphanol may therefore provide clinical benefits in patients with obesity.
肥胖是术后肺部并发症（PPCs）的一个危险因素。最近的研究报告了κ阿片受体（KOR）的肺保护作用。丁丙诺啡是一种具有强 KOR 激动作用的麻醉剂，其在肺保护方面的作用尚不确定。在这里，我们假设丁丙诺啡对接受腹腔镜减重手术的肥胖患者的肺功能有保护作用。
体重指数（BMI）≥30kg/m2的拟行腹腔镜减重手术的患者被随机分为丁丙诺啡组或生理盐水组。丁丙诺啡在诱导前 5 分钟给予初始负荷剂量 10μg/kg，然后在手术期间给予 5μg/（kg·h）。主要结局是动脉-肺泡氧分压比（a/A 比）。次要结局包括其他肺变量、反映肺损伤的生物标志物以及术后 7 天内 PPCs 的发生率。
与对照组相比，丁丙诺啡组患者在手术开始后 1 小时（68±7 vs. 55±8，P<0.001）、手术结束时（73±8 vs. 59±7，P<0.001）和拔管后 1 小时（83±9 vs. 70±5，P<0.001）的 a/A 比更高。此外，在丁丙诺啡组，死腔与潮气量比在同一时间点显著低于对照组（均 P<0.001）。在对照组中，反映肺损伤的生物标志物水平在术后 3、6、12 和 24 小时均显著高于丁丙诺啡组（均 P<0.001）。两组 PPCs 的发生率相似。
丁丙诺啡通过改善肥胖患者腹腔镜减重手术后的氧合和减少死腔通气来保护肺功能。因此，丁丙诺啡可能对肥胖患者有临床益处。
