环泊酚复合舒芬太尼用于不同人群胃镜检查的半数有效剂量

Median Effective Dose of Ciprofol Combined with Sufentanil for Gastroscope in Different Populations

目的测定并比较环泊酚用于不同性别、不同年龄的患者进行无痛胃镜检查时的半数有效剂量(median effective dose,ED_(50))。方法选择2023年3~4月拟行胃镜检查或治疗的患者,按分层随机法纳入4组:第1组中青年男性患者,第2组中青年女性患者,第3组老年男性患者,第4组老年女性患者。所有患者均先静脉注射0.1μg·kg^(-1)的舒芬太尼。4组患者的环泊酚起始剂量均为0.4 mg·kg^(-1),相邻剂量比值为1:1.1。待患者睫毛反射消失后行胃镜检查,根据Dixon改良序贯法,若前一位患者在进镜过程中出现阳性反应(呛咳、皱眉、体动等),则该组的下一位患者接受环泊酚的剂量递增10%;否则判为阴性反应,该组的下一位患者接受环泊酚的剂量递减10%。将阳性反应转为阴性反应定义为转折点,每组出现7个转折点时终止该组试验。同时记录4组患者在胃镜检查中,不同时间点的血流动力学参数、血氧饱和度以及发生的不良反应。采用Probit回归分析法分别计算4组患者使用环泊酚的ED_(50),并进行组间比较。结果环泊酚复合0.1μg·kg^(-1)舒芬太尼用于中青年男性、中青年女性、老年男性和老年女性患者胃镜检查的ED_(50)分别为0.409、0.373、0.356、0.327 mg·kg^(-1)。中青年男性组环泊酚的ED_(50)显著高于中青年女性组和老年男性组(P<0.05);老年女性组环泊酚的ED_(50);显著低于中青年女性组和老年男性组(P<0.05)。结论环泊酚用于不同性别、不同年龄的患者胃镜检查的ED_(50)不同,女性患者低于男性患者,老年患者低于中青年患者。

OBJECTIVE To test and compare the median effective dose(ED_(50))of ciprofol for gastroscope in patients of different genders and ages.METHODS Patients who planed to undergo gastroscope examination and treatment from March 2023 to April 2023 were selected,and divided into four groups according to stratified random method:N1 group(non-elderly male patients),N2 group(non-elderly female patients),N3 group(elderly male patients),and N4 group(elderly female patients).All patients received intravenous injection of 0.1μg·kg^(−1)sufentanil followed by injection of the test dose of ciprofol according to Dixon’s modified sequential method.Gastroscope was performed after the disappearance of the eyelash reflex.The initial dose of ciprofol in all four groups was 0.4 mg·kg^(−1),and the ratio of adjacent doses was 1∶1.1.The next patient would receive a 10%increase in the dose of ciprofol if the patient experienced positive reactions such as coughing,frowning,and body movements during the endoscopy process.Otherwise,it would be judged as a negative reaction,and the next patient would receive a 10%decrease in the dose of ciprofol.The transition from a positive reaction to a negative reaction was defined as a turning point,and the study was terminated when seven turning points occurred.Hemodynamic parameters,oxygen saturation and adverse reactions were recorded at different time points.The Probit regression analysis method was used to calculate the ED_(50)of ciprofol for four groups.RESULTS The ED_(50)of ciprofol combined with 0.1μg·kg^(−1)sufentanil for gastroscope in the non-elderly men,non-elderly women,elderly men,and elderly women were 0.409,0.373,0.356,0.327 mg·kg^(−1),respectively.The ED_(50)of ciprofol in the N1 group was significantly higher compared with the N2 group and N3 group(P<0.05).The ED_(50)of ciprofol in the N4 group was significantly lower compared with the N2 group and N3 group(P<0.05).CONCLUSION The ED_(50)of ciprofol is significantly different among gastroscope patients of different genders and ages,which is lower in female patients than in male patients,and is lower in older patients than in non-elderly patients.