Gu Xiao-Yu, Cao Jin-Feng, Zhang Xin-Yang, Cheng Yao, Jiang Liu-Qin
Department of Anesthesiology, NO.215 Hospital of Shaanxi Nuclear Industry, Xianyang, People's Republic of China.
Drug Des Devel Ther. 2025 Aug 27;19:7415-7426. doi: 10.2147/DDDT.S540089. eCollection 2025.
To compare nalbuphine versus alfentanil combined with etomidate-propofol for safety and efficacy during painless gastroscopy in decompensated cirrhosis patients.
One hundred and seventy-five advanced cirrhosis patients were randomized to receive Nalbuphine (0.1 to 0.15 mg·kg¹ IV bolus) or Alfentanil (5 to 6 μg·kg¹ IV bolus). The primary outcome was the incidence of adverse events during and within 48 hours after gastroscopy. Other outcomes included hemodynamic parameters, BIS, adverse events and time during the PACU, first-attempt induction success, etomidate-propofol dosage, induction time, duration of gastroscopy, awakening time, along with the Aldrete score. Additionally, blood samples for ALT, AST, creatinine, and urea nitrogen were drawn within the first 24 hours after gastroscopy.
The complication rates were 37.21% for nalbuphine and 11.24% for alfentanil group within 48 hours, exhibited a significantly difference ( = 0.00). Compared to the nalbuphine group, the RR of the alfentanil group was lower at T (post-induction stabilization, = 0.03) and T (the end of procedure, = 0.03). The SpO of the alfentanil group were lower at T ( = 0.01). The recovery time in alfentanil group was shorter ( = 0.01). Additionally, compared to pre-gastroscopy levels, the nalbuphine group showed significant decreases in serum ALT (P = 0.00) and AST levels (P = 0.00) postoperatively while alfentanil group exhibited significant reductions in ALT ( = 0.00) and BUN ( = 0.01) levels, along with a significant increase in Cr ( = 0.00). However, no significant differences existed in intraoperative or PACU complications, first-attempt induction success, dosage of etomidate-propofol, Aldrete score, induction time, operation time and awakening time ( > 0.05).
Alfentanil demonstrates fewer postoperative complications and faster recovery than nalbuphine, potentially making it preferable for painless gastroscopy in decompensated cirrhosis.
比较纳布啡与阿芬太尼联合依托咪酯 - 丙泊酚用于失代偿期肝硬化患者无痛胃镜检查时的安全性和有效性。
175例晚期肝硬化患者被随机分为接受纳布啡（0.1至0.15mg·kg⁻¹静脉推注）或阿芬太尼（5至6μg·kg⁻¹静脉推注）。主要结局是胃镜检查期间及检查后48小时内不良事件的发生率。其他结局包括血流动力学参数、脑电双频指数（BIS）、麻醉后恢复室（PACU）期间的不良事件和时间、首次诱导成功情况、依托咪酯 - 丙泊酚用量、诱导时间、胃镜检查持续时间、苏醒时间以及Aldrete评分。此外，在胃镜检查后24小时内采集谷丙转氨酶（ALT）、谷草转氨酶（AST）、肌酐和尿素氮的血样。
纳布啡组48小时内并发症发生率为37.21%，阿芬太尼组为11.24%，差异有统计学意义（P = 0.00）。与纳布啡组相比，阿芬太尼组在T₁（诱导后稳定期，P = 0.03）和T₂（手术结束时，P = 0.03）时心率（RR）较低。阿芬太尼组在T₁时血氧饱和度（SpO₂）较低（P = 0.01）。阿芬太尼组恢复时间较短（P = 0.01）。此外，与胃镜检查前水平相比，纳布啡组术后血清ALT（P = 0.00）和AST水平显著降低（P = 0.00），而阿芬太尼组ALT（P = 0.00）和尿素氮（P = 0.01）水平显著降低，肌酐（P = 0.00）水平显著升高。然而，术中或PACU并发症、首次诱导成功情况、依托咪酯 - 丙泊酚用量、Aldrete评分、诱导时间、手术时间和苏醒时间方面无显著差异（P > 0.05）。
与纳布啡相比，阿芬太尼术后并发症更少，恢复更快，可能更适合用于失代偿期肝硬化患者的无痛胃镜检查。
