不同剂量环泊酚在老年患者全身麻醉诱导中的应用

Application of different doses of ciprofol in general anesthesia induction in elderly patients

目的分析不同剂量环泊酚用于老年患者的全身麻醉诱导效果,以及对患者血流动力学的影响。方法将择期手术的120例老年患者随机纳入环泊酚0.2 mg·kg^(-1)组(C_(0.2)组)、环泊酚0.3 mg·kg^(-1)组(C_(0.3)组)和环泊酚0.4 mg·kg^(-1)组(C_(0.4)组),每组40例。依照分组情况静脉注射环泊酚对应剂量,注射时间30 s,并静脉注射罗库溴铵0.6 mg·kg^(-1)、舒芬太尼0.5μg·kg^(-1)诱导,后给予环泊酚0.8~2.4 mg·kg^(-1)·h^(-1)、瑞芬太尼8~15μg·kg^(-1)·h-1静脉泵注,1%七氟烷吸入麻醉维持,术中维持脑电双频指数(BIS)在40~60。监测患者平均动脉压(MAP)、心率(HR)和BIS,记录麻醉诱导成功率、补救镇静例数和意识消失时间,观察不良反应发生情况。结果3组麻醉诱导后即刻(T_(1))、气管插管后10 s(T_(2))、气管插管后3 min(T_(3))的MAP、HR、BIS均显著低于同组入室时水平(P<0.05),C_(0.4)组T_(1)~T_(3)的MAP、HR显著低于C_(0.2)组和C_(0.3)组(P<0.05),C_(0.3)组与C_(0.2)组T_(1)~T_(3)的MAP、HR比较无显著差异(P>0.05)。3组麻醉诱导成功率比较无显著差异(P>0.05),C_(0.2)组补救镇静率显著高于C_(0.3)组和C_(0.4)组(P<0.05),意识消失时间显著长于C_(0.3)组和C_(0.4)组(P<0.05);C_(0.3)组与C_(0.4)组的补救镇静率、意识消失时间比较无显著差异(P>0.05)。C_(0.4)组低血压、心动过缓发生率显著高于C_(0.2)组和C_(0.3)组(P<0.05),C_(0.3)组与C_(0.2)组的低血压、心动过缓发生率比较无显著差异(P>0.05)。结论环泊酚0.3 mg·kg^(-1)用于老年患者全身麻醉诱导具有良好的安全性和有效性。

AIM To analyze the effects of different doses of ciprofol on general anesthesia induction in elderly patients,and the influence on hemodynamics during general anesthesia induction.METHODS One hundred and twenty elderly patients undergoing elective surgery were randomly included in ciprofol 0.2 mg·kg^(-1)group(C_(0.2) group),ciprofol 0.3 mg·kg^(-1)group(C_(0.3) group)and ciprofol 0.4 mg·kg^(-1)group(C_(0.4) group),with 40 cases in each group.The corresponding dose of ciprofol was injected intravenously according to the group,and the injection time was 30 s.And all patients induced by rocuronium 0.6 mg·kg^(-1)and sufentanil 0.5μg·kg^(-1)were injected intravenously,followed by ciprofol 0.8-2.4 mg·kg^(-1)·h^(-1),remifentanil 8-15μg·kg^(-1)·h^(-1)was injected intravenously and 1%sevoflurane was inhaled for anesthesia maintenance.The bispectral index(BIS)was maintained 40~60 during the operation.The mean arterial pressure(MAP),heart rate(HR)and BIS of the patients were monitored,the success rate of anesthesia induction,the number of cases of remedial sedation and the time of loss of consciousness were recorded,and the occurrence of adverse reactions were observed.RESULTS The MAP,HR and BIS of the three groups immediately after anesthesia induction(T_(1)),10 s after tracheal intubation(T_(2))and 3 min after tracheal intubation(T_(3))were significantly lower than those of the same group at the time of entering the operating room(P<0.05),and the MAP and HR of T_(1)-T_(3) in the C_(0.4) group were significantly lower than those in the C_(0.2) group and C_(0.3) groups(P<0.05).There were no significant differences in MAP and HR of T_(1)-T_(3) between the C_(0.3) group and C_(0.2) group(P>0.05).There were no significant differences in the success rate of anesthesia induction among the three groups(P>0.05).The rate of remedial sedation in the C_(0.2) group was significantly higher than that in the C_(0.3) group and C_(0.4) group(P<0.05),and the time of consciousness loss was significantly longer than that in the C_(0.3) group and C_(0.4) group(P<0.05).There was no significant difference in rate of remedial sedation and consciousness loss time between the C_(0.3) group and C_(0.4) group(P>0.05).The incidence of hypotension and bradycardia in the C_(0.4) group was significantly higher than that in the C_(0.2) group and C_(0.3) group(P<0.05),but there was no significant difference in the incidence of hypotension and bradycardia between the C_(0.3) group and C_(0.2) group(P>0.05).CONCLUSION Ciprofol 0.3 mg·kg^(-1)has good safety and efficacy for general anesthesia induction in elderly patients.