肥胖症患者行腹腔镜袖状胃切除术中应用环泊酚与丙泊酚行全身麻醉诱导的安全性对比研究

Comparative study on the safety of using ciprofol and propofol in induction of general anesthesia for laparoscopic sleeve gastrectomy in obesity patients

摘要:

目的 比较接受腹腔镜袖状胃切除术（LSG）的肥胖症患者，其采用环泊酚和丙泊酚行全身麻醉诱导的安全性。方法 选取2021年1月－2023年12月于该院开展LSG的肥胖症患者170例，采用随机数表法将患者分为环泊酚组和丙泊酚组，各85例。两组均给予相同镇静（右美托咪定）、镇痛（瑞芬太尼）和肌松药物（顺阿曲库铵），环泊酚组诱导期静脉给予环泊酚0.40 mg/kg，丙泊酚组同期静脉给予丙泊酚2.00 mg/kg。比较两组患者术后2 d低分钟通气量的发生率；比较两组患者诱导前（T₀）、插管后（T₁）、拔管前（T₂）和拔管后（T₃）的平均动脉压（MAP）、心率（HR）和经皮动脉血氧饱和度（SpO₂）；比较两组患者诱导时间、手术时间、苏醒时间、离开麻醉恢复室（PACU）时间、诱导插管期间不良反应的情况，以及术后首次下床活动时间、术后首次排气时间和住院时间；比较两组患者术后6、12和24 h的疼痛视觉模拟评分法（VAS）评分。结果 环泊酚组术后2 d的低分钟通气量的发生率为32.94%，明显高于丙泊酚组的10.59%，差异有统计学意义（P < 0.05）。环泊酚组T₁和T₂时点的MAP分别为（98.49±6.88）和（99.87±10.02）mmHg，明显低于丙泊酚组的（104.81±11.09）和（105.07±11.56）mmHg，差异均有统计学意义（P < 0.05）；环泊酚组T₁、T₂和T₃时点的HR分别为（89.18±13.21）、（88.47±12.84）和（76.96±11.42）次/min，明显低于丙泊酚组的（95.80±12.86）、（96.07±15.09）和（86.43±10.43）次/min，差异均有统计学意义（P < 0.05）；环泊酚组T₂时点的MAP明显高于T₀时点，T₁和T₂时点的HR高于T₀时点，差异均有统计学意义（P < 0.05）；丙泊酚组T₁和T₂时点的MAP明显高于T₀时点，T₃时点的MAP明显低于T₀时点，T₁、T₂和T₃时点的HR明显高于T₀时点，T₃时点的SpO₂明显低于T₀时点，差异均有统计学意义（P < 0.05）。环泊酚组T₃时点的SpO₂为（99.70±0.61）%，明显高于丙泊酚组的（97.13±1.55）%，差异有统计学意义（P < 0.05）。环泊酚组诱导时间为（70.45±4.74）min，明显短于丙泊酚组的（75.07±4.23）min；丙泊酚组苏醒时间为（30.00±13.97）min，明显短于丙泊酚组的（40.00±13.64）min；环泊酚组离开PACU时间为（40.00±13.00）min，明显短于丙泊酚组的（47.63±13.33）min；环泊酚组住院时间为（10.14±1.58）d，明显短于丙泊酚组的（11.56±1.84）d；环泊酚组术后首次排气时间为（28.64±4.31）h，明显短于丙泊酚组的（36.20±5.16）h，差异均有统计学意义（P < 0.05）。两组患者术后6、12和24 h的VAS评分比较，差异均无统计学意义（P > 0.05）。环泊酚组的不良反应发生率为5.88%，明显低于丙泊酚组的11.76%，差异有统计学意义（P < 0.05）。结论 与丙泊酚相比，在肥胖症患者LSG中采用环泊酚实施麻醉诱导，可加强术中血流动力学的稳定性，还可缩短诱导时间、苏醒时间、离开PACU时间和住院时间，降低不良反应的发生率。值得临床推广应用。

Abstract:

Objective To compare the safety of general anesthesia induction with ciprofol and propofol in obesity patients undergoing laparoscopic sleeve gastrectomy (LSG).Methods 170 obesity patients who underwent LSG from January 2021 to December 2023 were selected. The patients were divided into the ciprofol group and the propofol group using the random number table method, with 85 cases in each group. Both groups were given the same sedative (dexmedetomidine), analgesic (remifentanil) and muscle relaxant (cisatracurium besilate). The ciprofol group was intravenously administered ciprofol at a dose of 0.40 mg/kg during the induction period, while the propofol group was intravenously administered propofol at a dose of 2.00 mg/kg in the same period. The incidence of low minute ventilation within 2 days after surgery was compared between the two groups. The mean arterial pressure (MAP), heart rate (HR) and percutaneous arterial oxygen saturation (SpO₂) were compared at four time points: before induction (T₀), after intubation (T₁), before extubation (T₂) and after extubation (T₃). The induction time, operation time, awakening time, departure time from postanesthesia care unit (PACU), incidence of adverse reactions during induction and intubation, as well as first time getting out of bed after surgery, the time to first postoperative flatus and length of hospital stay were compared between the two groups. Additionally, the visual analogue scale (VAS) scores for pain were compared at 6, 12 and 24 hours after surgery.Results The incidence of low minute ventilation volume in the ciprofol group was 32.94% within 2 days after surgery, which was significantly higher than 10.59% in the propofol group, with a statistically significant difference (P < 0.05). The MAP of the ciprofol group at T₁ and T₂ were (98.49 ± 6.88) mmHg and (99.87 ± 10.02) mmHg respectively, which were significantly lower than those of the propofol group [(104.81 ± 11.09) mmHg and (105.07 ± 11.56) mmHg], with statistically significant differences (P < 0.05). The HR of the ciprofol group at T₁, T₂ and T₃ were (89.18 ± 13.21) times/min, (88.47 ± 12.84) times/min and (76.96 ± 11.42) times/min respectively, which were significantly lower than those of the propofol group [(95.80 ± 12.86) times/min, (96.07 ± 15.09) times/min and (86.43 ± 10.43) times/min], with statistically significant differences (P < 0.05). In the ciprofol group, the MAP at T₂ was significantly higher than that at T₀, and the HR at T₁ and T₂ was significantly higher than that at T₀, with statistically significant differences (P < 0.05). In the propofol group, the MAP at T₁ and T₂ was significantly higher than that at T₀, the MAP at T₃ was significantly lower than that at T₀, the HR at T₁, T₂ and T₃ was significantly higher than that at T₀, and the SpO₂ at T₃ was significantly lower than that at T₀, with statistically significant differences (P < 0.05). The SpO₂ of the ciprofol group at T₃ was (99.70 ± 0.61)%, which was significantly higher than (97.13 ± 1.55)% of the propofol group, with a statistically significant difference (P < 0.05). The induction time of the ciprofol group was (70.45 ± 4.74) minutes, which was significantly shorter than (75.07 ± 4.23) minutes of the propofol group; the awakening time of ciprofol group was (30.00 ± 13.97) minutes, which was significantly shorter than (40.00 ± 13.64) minutes of the propofol group; the departure time from PACU of the ciprofol group was (40.00 ± 13.00) minutes, which was significantly shorter than (47.63 ± 13.33) minutes of the propofol group; the length of hospital stay of the ciprofol group was (10.14 ± 1.58) days, which was significantly shorter than (11.56 ± 1.84) days of the propofol group; the time to first postoperative flatus of the ciprofol group was (28.64 ± 4.31) hours, which was significantly shorter than (36.20 ± 5.16) hours of the propofol group, with statistically significant differences (P < 0.05). There were no statistically significant differences in VAS scores at 6, 12 and 24 hours after surgery between the two groups (P > 0.05). The incidence of adverse reactions in the ciprofol group was 5.88%, which was significantly lower than 11.76% in the propofol group, with a statistically significant difference (P < 0.05).Conclusion Compared with propofol, ciprofol for anesthesia induction in obesity patients undergoing LSG can improve the stability of intraoperative hemodynamics, shorten the induction time, awakening time, departure time from PACU and length of hospital stay, and reduce the incidence of adverse reactions, which is worthy of clinical promotion and application.