环泊酚用于全麻诱导安全性及有效性分析

Safety and Efficacy Analysis of Ciprofol in Inducing General Anesthesia Patients

目的研究环泊酚麻醉诱导时麻醉效果及其对血流动力学的影响。方法采用随机、双盲、对照的方式选择锦州医科大学附属第一医院2023年2月至2023年7月美国标准协会(American Standards Association,ASA)分级Ⅰ或Ⅱ级需气管插管的择期手术患者150例,随机分为3组。CP组(环泊酚实验组):采用0.4 mg/kg环泊酚诱导;E组(依托咪酯对照组):采用0.3 mg/kg依托咪酯诱导;P组(丙泊酚对照组):采用丙泊酚2 mg/kg诱导。记录患者镇静成功情况、诱导期追加药物例数及追加次数,诱导开始至睫毛反射消失时间、诱导开始至BIS≤60时间、气管插管即刻的脑电双频谱指数(bispectral index,BIS)值,同时记录麻醉诱导前4 min(T0)、睫毛反射消失时(T1)、气管插管完成时(T2)、气管插管结束后4 min(T3)四个时间点患者的心率、平均动脉压的变化情况;观察不良反应发生,如注射痛、低血压、窦性心动过缓、窦性心动过速;观察苏醒期不良反应,如苏醒期躁动、恶心呕吐及术中知晓情况。结果3组药物镇静成功率均为100%,均未追加镇静药物,CP组诱导至睫毛反射消失时间和麻醉成功时间长于E组与P组(P<0.05),CP组心率变化和P组差异无统计学意义(P>0.05),在T2时心率低于E组(P<0.05),CP组患者的平均动脉压下降程度和P组差异无统计学意义(P>0.05),在T1至T3时均低于E组(P<0.05)。CP组患者诱导期不良反应总发生率低于E组和P组;CP组给药时肌阵挛(P<0.05)、恶心呕吐(P<0.05)发生率显著低于E组,注射痛显著低于P组(P<0.05)。结论环泊酚、依托咪酯和丙泊酚均能满足麻醉诱导期镇静需要并能达到有效的麻醉深度;环泊酚麻醉成功时间略长于依托咪酯和丙泊酚。环泊酚和依托咪酯相比,环泊酚诱导后患者血压下降程度更大,依托咪酯在气管插管操作时更易引起的心率血压的显著升高,且依托咪酯肌阵挛发生率最高,心动过速、恶心呕吐的发生率也高于环泊酚。环泊酚和丙泊酚相比,环泊酚诱导血流动力学指标和丙泊酚相似,环泊酚注射痛的发生率远低于丙泊酚,并发症总发生率低于丙泊酚,其安全性优于丙泊酚。

Objective To study the anesthesia effect of ciprofol and its influence on hemodynamics during anesthesia induction.Methods A total of 150 patients with gradeⅠorⅡof American Standards Association(ASA)requiring tracheal intubation in the First Affiliated Hospital of Jinzhou Medical University from February 2023 to July 2023 were selected in a randomized,double-blind,controlled way and randomly divided into 3 groups.CP group(cyclopofol experimental group):0.4 mg/kg cyclopofol induction;group E(etomidate control group):0.3 mg/kg etomidate induction;group P(propofol control group):Propofol 2 mg/kg induction.The successful sedation of patients,the number of cases and times of drug addition during the induction period,the time from the beginning of induction to the disappearance of eyelash reflex,the time from the beginning of induction to BIS≤60,and the value of bispectral index(BIS)immediately after endotracheal intubation were recorded.At the same time,the changes of heart rate and mean arterial pressure were recorded at 4 min before anesthesia induction(T0),when eyelash reflex disappeared(T1),when tracheal intubation was completed(T2),and 4 min after tracheal intubation(T3);adverse reactions such as injection pain,hypotension,sinus bradycardia and sinus tachycardia were observed;the adverse reactions,such as restlessness,nausea and vomiting,were observed during the recovery period.Results The success rate of drug sedation in the 3 groups was 100%,and no sedation drugs were added.The time from induction to eyelash reflex disappearance and the successful anesthesia time in CP group were longer than those in E and P groups(P<0.05),the heart rate changes in CP group were not significantly different from those in P group(P>0.05),and the heart rate at T2 was lower than that in E group(P<0.05).The decrease of mean arterial pressure in CP group was not significantly different from that in P group(P>0.05),and was lower than that in E group at T1 to T3(P<0.05).The total incidence of adverse reactions in CP group was lower than that in E group and P group;the incidence of myoclonus(P<0.05),nausea and vomiting(P<0.05)during administration in CP group was significantly lower than that in E group,and the injection pain was significantly lower than that in P group(P<0.05).Conclusion Cyclopofol,etomidate and propofol can meet the sedation needs and achieve effective anesthesia depth during anesthesia induction;the success time of cypofol is slightly longer than that of etomidate and propofol.Compared with etomidate,the blood pressure of patients induced by cipofol decrease more significantly.Etomidate is more likely to cause a significant increase in heart rate and blood pressure during tracheal intubation,and the incidence of etomidate myoclonus is the highest,and the incidence of tachycardia,nausea and vomiting is also higher than that of cipofol.Compared with propofol,the induced hemodynamic indexes of cyclopofol are similar to that of propofol.The incidence of pain and total complication of cyclopofol injection is much lower than that of propofol,and its safety is better than that of propofol.