环泊酚麻醉诱导对高龄甲状腺癌根治术患者血流动力学的影响

Effect of ciprofol anesthesia induction on hemodynamics in elderly patients undergoing radical thyroidectomy

目的比较环泊酚与丙泊酚麻醉诱导对高龄甲状腺癌根治术患者血流动力学的影响。方法选择北部战区总医院和平院区拟行甲状腺切除术患者为研究对象,共64例,随机分为2组,每组32例。对照组给予丙泊酚2~2.5 mg/kg麻醉诱导,试验组给予环泊酚0.5 mg/kg。记录患者麻醉前(T_(0))、麻醉诱导后5 min(T_(1))、气管插管即刻(T_(2))、气管插管后5 min(T_(3))的心率(HR)、平均动脉压(MAP)、脑电双频指数(BIS),记录T_(0)~T_(1)时HR、MAP的变化值(ΔHR、ΔMAP),并记录心血管相关事件的发生率。分别于T_(1)和T_(3)测定动脉血乳酸、血糖、促肾上腺皮质激素。结果对照组在T_(0)~T_(1)时刻的ΔMAP和ΔHR分别为(23.8±8.6)mmHg、(15.7±9.0)次/min,试验组为(14.1±5.5)mmHg、(9.1±7.6)次/min,试验组HR和MAP变化幅度更小(P<0.05)。对照组与试验组分别发生低血压8例(25%)、2例(6.25%),试验组低血压发生率显著低于对照组(P<0.05)。两组患者各时间点BIS值及T_(1)和T_(3)时血糖、乳酸、ACTH水平变化差异均无统计学意义(P>0.05)。试验组发生1例(3.13%)注射痛,对照组发生11例(34.3%),试验组少于对照组,差异有统计学意义(P<0.05)。对照组呛咳发生率为15.6%,而试验组仅为12.5%,差异无统计学意义(P>0.05)。结论环泊酚对患者血流动力学影响更小,可安全用于高龄患者甲状腺癌根治术的麻醉诱导。

Objective To compare the hemodynamic effects of ciprofol and propofol on elderly patients undergoing radical thyroidectomy.Methods Sixty-four patients undergoing thyroidectomy in the Heping Hospital of General Hospital of Northern Theater Command were chosen and randomly divided into two groups,32 cases in each group.For anesthesia induction the control group was given 2~2.5 mg/kg propofol,and experiment group was given 0.5 mg/kg ciprofol.HR,MAP and BIS of patients were recorded before anesthesia(T_(0)),5 min after induction of anesthesia(T_(1)),immediately after intubation(T_(2)),and 5 min after intubation(T_(3)).ΔHR andΔMAP(the changes of HR and MAP)from T_(0) to T_(1) were recorded.The incidence of cardiovascular events were recorded.Arterial lactate,blood glucose and adrenocorticotropin were measured at T_(1) and T_(3) respectively.Results The changes of MAP and HR at T_(0)~T_(1) were(23.8±8.6)mmHg and(15.7±9.0)bpm in control group,and(14.1±5.5)mmHg and(9.1±7.6)bpm in experiment group,and the changes of HR and MAP in experiment group were smaller(P<0.05).Hypotension occurred in 8 patients(25%)in control group and 2 patients(6.25%)in experiment group.The incidence of hypotension in experiment group was significantly lower than that in control group(P<0.05).There was no significant difference in the change in BIS value at each time point or the levels of blood glucose,lactic acid and ACTH at T_(1) and T_(3) between the two groups(P>0.05).Injection pain occurred in 1 case(3.13%)in experiment group,which was less than that(11 cases,34.3%)in control group,and the difference was statistically significant(P<0.05).The incidence of choking cough was 15.6%in control group and 12.5%in experimental group,but there was no statistical significance between the groups(P>0.05).Conclusion Ciprofol has less influence on hemodynamics and can be safely used in anesthesia induction of radical thyroidectomy in elderly patients.