环泊酚在老年患者胸腔镜手术静-吸复合麻醉中的有效性与安全性

Efficacy and safety of ciprofol in combined intravenous and inhalation anesthesia in elderly patients undergoing thoracoscopic surgery

目的 探讨环泊酚在老年患者胸腔镜手术静-吸复合麻醉中应用的有效性与安全性。方法 回顾性分析2021年1月至2022年7月择期行胸腔镜手术的老年患者806例,男416例,女390例,年龄65~85岁,BMI 16~30 kg/m^(2),ASAⅠ—Ⅲ级。根据术中不同静脉麻醉药物将老年患者分为两组:环泊酚组(C组,n=229)和丙泊酚组(P组,n=577)。使用1∶1倾向性评分匹配法(PSM)平衡两组术前和术中指标。采用多因素Logistic回归分析静脉麻醉药与不良反应(低血压、心动过缓、苏醒期低氧血症和术后恶心呕吐)发生的相关性。采用多因素线性回归分析静脉麻醉药与麻醉后早期恢复指标(拔管时间、PACU停留时间和术后住院时间)的相关性。结果 与P组比较,C组血管活性药物总用量明显减少(P<0.05),拔管时间、PACU停留时间明显缩短(P<0.05)。多因素Logistic回归分析显示,使用环泊酚与术中低血压发生率降低(OR=0.378,95%CI 0.236~0.603,P<0.001)和苏醒期低氧血症发生率降低(OR=0.542,95%CI 0.336~0.874,P=0.012)相关。多因素线性回归分析显示,使用环泊酚与拔管时间、麻醉后监护室停留时间缩短相关(P<0.001)。结论 与丙泊酚比较,使用环泊酚进行静-吸复合麻醉可明显降低老年患者麻醉药物不良反应发生率,同时有利于患者麻醉后早期恢复。

Objective To research the efficacy and safety of ciprofol in combined intravenous and inhalation anesthesia in elderly patients undergoing thoracoscopic surgery.Methods A retrospective analysis was conducted on 806 elderly patients who underwent thoracoscopic surgery from January 2021 to July 2022,416 males and 390 females,aged 65-85 years,BMI 16-30 kg/m^(2),ASA physical statusⅠ-Ⅲ.Patients were divided into two groups according to different intravenous anesthesia drugs during the surgery:ciprofol group(group C,n=229)and propofol group(group P,n=577).The preoperative and intraoperative indexes of the two groups were balanced by 1∶1 propensity score matching(PSM).Multivariate logistic regression was used to analyze the correlation between intravenous anesthetics and the incidence of adverse reactions(hypotension,bradycardia,hypoxemia during recovery,and postoperative nausea and vomiting).Multivariate linear regression was used to analyze the correlation between intravenous anesthetics and short-term recovery indicators after anesthesia(extubation time,postanesthesia care unit residence time,and length of postoperative hospitalization).Results Compared with group P,the total dosage of vasoactive drugs in group C were significantly reduced(P<0.05),extubation time and PACU residence time were significantly shortened(P<0.05).Multivariate logistic regression analysis showed that the use of ciprofol was associated with a reduced incidence of intraoperative hypotension(OR=0.378,95%CI 0.236-0.603,P<0.001)and hypoxemia during recovery(OR=0.542,95%CI 0.336-0.874,P=0.012).Multivariate linear regression analysis showed that the use of ciprofol was associated with the reduction of extubation time and PACU residence time(P<0.001).Conclusion Compared with propofol,combined intravenous and inhalation anesthesia with ciprofol can significantly reduce the incidence of anesthetic adverse reactions in elderly patients,and is conducive to short-term recovery after anesthesia.