环泊酚与丙泊酚诱导镇静用于无痛胃镜检查对咽部吞咽功能的影响：一项前瞻性随机对照试验

Effect of ciprofol- and propofol-induced sedation for painless gastroscopy on pharyngeal swallowing function: a randomized controlled trial

摘要:

目的 比较环泊酚与丙泊酚对无痛胃镜检查患者咽部吞咽功能的影响。方法 选择2021年12月8日－2022年12月8日于该院行无痛胃镜检查的患者237例。采用随机数表法将患者分为丙泊酚组（P组，n = 121）和环泊酚组（C组，n = 116）。P组手控静脉注射丙泊酚剂量2.5 mg/kg，C组手控静脉注射环泊酚剂量0.6 mg/kg，推注时间 > 30 s。改良警觉/镇静评分量表（MOAA/S）评分 ≤ 1分时，行内镜检查。记录麻醉诱导前（T₁）、胃镜通过口腔时（T₂）、胃镜退出时（T₃）、入麻醉恢复室（PACU）时（T₄）和出PACU时（T₅）的血流动力学指标［平均动脉压（MAP）和心率（HR）］、麻醉相关情况［检查时间、镇静药物总剂量、补充镇静药物剂量、苏醒时间和PACU停留时间］、吞咽功能［吞咽困难严重性评分（DSS）、渗透-误吸量表（PAS）评分、喉内收反射发生情况和环杓关节松弛情况］和不良反应发生情况（注射痛、体动、呼吸抑制、呼吸暂停、气道梗阻、心动过缓和术后头晕）。结果 C组重度吞咽功能障碍发生率为12.9%，明显低于P组的33.1%；C组PAS评分7和8分的占比为12.9%，明显低于P组的33.1%；C组喉内收反射消失率为37.1%，明显低于P组的56.2%；C组环杓关节松弛率为42.2%，明显低于P组的56.2%，差异均有统计学意义（P < 0.05）。两组患者不同时点血流动力学指标、检查时间、苏醒时间和PACU停留时间比较，差异均无统计学意义（P > 0.05）。C组镇静药物总剂量和补充镇静药物剂量明显少于P组，差异均有统计学意义（P < 0.05）。C组体动发生率为15.5%，明显低于P组的31.4%，C组呼吸暂停发生率为0.0%，明显低于P组的5.0%，C组注射痛发生率为5.2%，明显低于P组的66.9%，差异均有统计学意义（P < 0.05）。两组患者呼吸抑制、气道梗阻、心动过缓及术后头晕发生率比较，差异均无统计学意义（P > 0.05）。结论 在胃镜检查时，与单独使用丙泊酚相比，单独应用环泊酚，可能更有利于患者在镇静状态下，保留一定的吞咽功能，还能减少体动的发生，降低误吸的发生风险。值得应用于临床。

Abstract:

Objective To compare the effects of ciprofol and propofol on the swallowing function of the pharynx in patients undergoing painless gastroscopy.Methods 237 patients who underwent painless gastroscopy from December 8, 2021 to December 8, 2022 were selected. The patients were divided into propofol group (group P, n = 121) and ciprofol group (group C, n = 116) by random number table method. In group P, the dose of propofol was 2.5 mg/kg by manual intravenous injection, and in group C, the dose of ciprofol was 0.6 mg/kg by manual intravenous injection. The injection time was more than 30 seconds. When the score of the modified observer’s assessment of alertness/sedation (MOAA/S) was ≤1, endoscopic examination was performed. Record hemodynamic indicators before anesthesia induction (T₁), when the gastroscopy passed through the mouth (T₂), when the gastroscopy exited (T₃), when entering the postanesthesia care unit (PACU) (T₄), and when leaving the PACU (T₅), anesthesia-related conditions (examination time, total dose of sedative drugs and dose of supplementary sedative drugs, recovery time, duration of stay in the PACU), swallowing function [dysphagia severity scale (DSS) scores, penetration-aspiration scale (PAS), occurrence of laryngeal adductor reflex and cricoarytenoid joint laxity], and occurrence of adverse reactions (body movement, respiratory depression, apnea, respiratory depression, tract obstruction, bradycardia and postoperative dizziness).Results The incidence of severe dysphagia in group C was 12.9%, significantly lower than 33.1% in group P; The proportion of patients with PAS scores of 7 and 8 in group C was 12.9%, significantly lower than 33.1% in group P; The disappearance rate of laryngeal adductor reflex in group C was 37.1%, significantly lower than 56.2% in group P; The relaxation rate of the cricoarytenoid joint in group C was 42.2%, significantly lower than 56.2% in group P, the differences were statistically significant (P < 0.05). There were no statistically significant differences in hemodynamic indicators of the two groups of patients at different time points, examination time, recovery time and PACU stay time between the two groups of patients (P > 0.05). The total dose of sedative drugs and the dose of supplementary sedative drugs in group C were significantly less than those in group P, and the differences were statistically significant (P < 0.05). The incidence of body movement in group C was 15.5%, significantly lower than 31.4% in group P; The incidence of apnea in group C was 0.0%, significantly lower than 5.0% in group P; The incidence of injection pain in group C was 5.2%, significantly lower than 66.9% in group P, the differences were statistically significant (P < 0.05). There was no statistically significant difference in the incidence of respiratory depression, tract obstruction, bradycardia and postoperative dizziness between the two groups of patients (P > 0.05).Conclusion During gastroscopy, compared with the use of propofol alone, the application of ciprofol alone may be more beneficial for patients to retain a certain degree of swallowing function in a sedative state, and it can also reduce the occurrence of body movement and lower the risk of aspiration. It is worth applying in clinical practice.