重度吸烟因素对复合阿芬太尼时环泊酚用于无痛胃镜检查术量效关系的影响

Effect of heavy smoking on dose-effect relationship of ciprofol for painless gastroscopy when combined with alfentanil

目的评价重度吸烟因素对复合阿芬太尼时环泊酚用于无痛胃镜检查术量效关系的影响。方法本研究为前瞻性研究。选取保定市第一中心医院2023年10月到2024年2月择期行无痛胃镜检查术男性患者,年龄18~64岁,BMI 18~28 kg/m^(2),ASA分级Ⅰ或Ⅱ级,根据患者吸烟情况分为非吸烟组和重度吸烟组(吸烟指数>400)。静脉注射阿芬太尼5μg/kg和环泊酚,待患者睫毛反射消失,下颌松弛后进行胃镜检查术。采用Dixon序贯法进行研究,环泊酚初始剂量为0.4 mg/kg,剂量梯度为0.04 mg/kg;环泊酚的剂量根据上一例患者的阳性或阴性反应而增加或减少。阳性反应定义为:注射环泊酚3 min后改良警觉/镇静评分仍>1分,或进镜时出现呛咳、吞咽、体动等影响操作的反应。采用probit法确定环泊酚用于无痛胃镜检查术的半数有效剂量(ED_(50))及其95%置信区间(CI)。结果非吸烟组最终纳入25例,重度吸烟组23例。非吸烟组ED_(50)(95%CI)为0.205(0.159~0.244)mg/kg;重度吸烟组ED_(50)(95%CI)为0.252(0.184~0.295)mg/kg。重度吸烟组ED_(50)高于非吸烟组(u=390,P=0.009)。结论重度吸烟可减弱复合阿芬太尼时环泊酚用于无痛胃镜检查术的镇静效力。

Objective To evaluate the effect of heavy smoking on the dose-effect relationship of ciprofol for painless gastroscopy when combined with alfentanil.Methods This was a prospective study.American Society of Anesthesiologists Physical Status classificationⅠorⅡmale patients,aged 18-64 yr,with body mass index of 18-28 kg/m^(2),undergoing elective painless gastroscopy from October 2023 to February 2024 in Baoding First Central Hospital,were divided into non-smoking group and heavy smoking group(smoking index>400)according to the status of smoking.Alfentanil 5μg/kg and ciprofol were intravenously injected,and gastroscopy was performed after the patient′s eyelash reflex disappeared and the jaw was relaxed.The study was performed by the Dixon′s up-and-down method,and the initial dose of ciprofol was 0.4 mg/kg.The dose of ciprofol increased or decreased by 0.04 mg/kg each time based on the positive or negative response of the previous patient.A positive response was defined as the Modified Observer′s Assessment of Alertness/Sedation Scale score being greater than 1 point at 3 min after ciprofol injection or the occurrence of coughing,swallowing,body movement,or other responses that affected the operation during the insertion of the endoscope.The median effective dose(ED_(50))and 95%confidence interval of propofol for painless gastroscopy were determined by the probit analysis.Results Twenty-five patients were finally included in non-smoking group and 23 patients in heavy smoking group.The ED_(50)(95%confidence interval)of ciprofol when combined with alfentanil was 0.205(0.159,0.244)mg/kg in non-smoking group and 0.252(0.184,0.295)mg/kg in heavy smoking group.The ED_(50) was significantly higher in heavy smoking group than in non-smoking group(u=390,P=0.009).Conclusions Heavy smoking can weaken the sedative potency of propofol for sedation when used for painless gastroscopy when combined with alfentanil.