摘要
目的比较不同剂量环泊酚用于老年患者腹腔镜胆囊手术全身麻醉维持的效果。方法选取2023年9-12月上海市浦东新区人民医院择期行腹腔镜胆囊手术的96例老年患者为研究对象,采用随机数字表法分为C1、C2、C3、C4组,每组24例。4组采用相同方法快速静脉诱导插管后,术中分别采用环泊酚0.6、0.8、1.0、1.2 mg·kg^(-1)·h^(-1)进行麻醉维持,联合泵注瑞芬太尼0.1μg·kg^(-1)·min^(-1)。观察并比较4组主要指标[入手术室10 min(T_(0))、诱导后气管插管前(T_(1))、插管后1 min(T_(2))、气腹后1 min(T_(3))、气腹后10 min(T_(4))、气腹后30 min(T_(5))、术毕时(T_(6))、拔管后(T_(7))的心率、收缩压、平均动脉压]、次要指标[拔管时改良警觉/镇静(MOAA/S)评分、拔管时间、苏醒时间]、术中环泊酚追加次数及术中辅助用药情况。结果T_(1)、T_(2)时4组收缩压、平均动脉压、心率均低于T_(0)时,T_(7)时高于T_(0)时(P<0.05)。T_(3)~T_(6)时C1组收缩压、平均动脉压、心率高于T_(0)时及同期C3、C4组(P<0.05)。T_(3)~T_(6)时C4组收缩压、平均动脉压、心率低于T_(0)时(P<0.05)。4组MOAA/S评分、拔管时间、苏醒时间比较,差异无统计学意义(P>0.05)。4组镇静成功率均为100%,均未追加环泊酚。C1组术中乌拉地尔使用率高于C2、C3、C4组(P<0.05);C4组术中麻黄碱使用率高于C1、C2、C3组(P<0.05)。结论环泊酚1.0 mg·kg^(-1)·h^(-1)的给药速率应用于老年患者腹腔镜胆囊手术麻醉维持的效果最优。
Objective To compare the efficacy of different doses of Ciprofol for the maintenance of general anesthesia in elderly patients undergoing laparoscopic cholecystectomy.Methods A total of 96 elderly patients who underwent elective laparoscopic cholecystectomy at People’s Hospital of Pudong New Area,Shanghai from September to December 2023 were selected as the research subjects.They were divided into groups C1,C2,C3 and C4,with 24 cases in each group using the random number table method.After rapid intravenous induction and intubation with the same method in the 4 groups,Ciprofol was administered intraoperatively at the rates of 0.6,0.8,1.0 and 1.2 mg·kg^(-1)·h^(-1) respectively for anesthesia maintenance,combined with continuous infusion of Remifentanil at 0.1μg·kg^(-1)·min^(-1).The primary indicators[heart rate(HR),systolic blood pressure(SBP)and mean arterial pressure(MAP)at 10 min after entering the operating room(T_(0)),before tracheal intubation after induction(T_(1)),1 min after intubation(T_(2)),1 min after pneumoperitoneum(T_(3)),10 min after pneumoperitoneum(T_(4)),30 min after pneumoperitoneum(T_(5)),at the end of surgery(T_(6))and after extubation(T_(7))],secondary indicators[modified Observer’s Assessment of Alertness/Sedation(MOAA/S)score at extubation,extubation time and recovery time],as well as the number of additional Ciprofol administrations and the use of adjuvant drugs during surgery were observed and compared among the 4 groups.Results At T_(1) and T_(2),the SBP,MAP and HR in the 4 groups were lower than those at T_(0),and higher at T_(7) than at T0(P<0.05).At T_(3) to T_(6),the SBP,MAP and HR in group C1 were higher than those at T_(0) and those in groups C3 and C4 at the same time points(P<0.05).At T_(3) to T_(6),SBP,MAP and HR in group C4 were lower than those at T0(P<0.05).There were no statistically significant differences in MOAA/S score,extubation time and recovery time among the 4 groups(P>0.05).The sedation success rate was 100%in all groups,and no additional Ciprofol was administered in any group.The usage rate of Urapidil during surgery in group C1 was higher than that in groups C2,C3 and C4(P<0.05);the usage rate of Ephedrine during surgery in group C4 was higher than that in groups C1,C2 and C3(P<0.05).Conclusion The infusion rate of Ciprofol at 1.0 mg·kg^(-1)·h^(-1) has the best effect when used for the maintenance of anesthesia in elderly patients undergoing laparoscopic cholecystectomy.
作者
杜策
辜乙
夏建华
DU Ce;GU Yi;XIA Jianhua(Department of Anesthesiology,Integrated Traditional Chinese and Western Medicine Hospital of Baoshan District,Shanghai 201900,China;Department of Pain Medicine,Pujiang Hospital of Minhang District,Shanghai 201100,China;Department of Anesthesiology,People’s Hospital of Pudong New Area,Shanghai 200135,China)
出处
《重庆医学》
2026年第2期387-392,共6页
Chongqing Medical Journal
基金
上海市卫生健康委员会科研项目(202340099)
上海市浦东新区卫生健康委员会学科建设计划项目(PWZzk2022-13)。
关键词
环泊酚
老年人
全身麻醉
麻醉维持
腹腔镜胆囊手术
血流动力学
Ciprofol
elderly people
general anesthesia
anesthesia maintenance
laparoscopic cholecystectomy
hemodynamics
