环泊酚复合不同血浆靶控质量浓度阿芬太尼抑制宫腔镜手术患者体动反应有效剂量的研究

Effective does of ciprofol combined with different plasma target-controlled concentrations of alfentanil for inhibiting body movement response in patients undergoing hysteroscopic treatment

关键词:  环泊酚  阿芬太尼  宫腔镜  有效剂量  量效关系  靶控输注

Key words:  ciprofol  alfentanil  hysteroscopy  effective does  dose-effect relationship  target-controlled infusion

摘要:

目的 探讨环泊酚复合不同血浆靶控质量浓度阿芬太尼抑制宫腔镜治疗术患者体动反应的有效剂 量。方法 选取佛山复星禅诚医院2023年8月至2023年10月择期非插管静脉全麻下行宫腔镜治疗术患者40例， 随机分为环泊酚复合20 μg/L阿芬太尼组（A组）、环泊酚复合40 μg/L阿芬太尼组（B组），每组20例。入室后血浆靶 控输注阿芬太尼，当靶控质量浓度与效应室靶控质量浓度达到平衡后，输注环泊酚诱导量0.35 mg/kg，随后按序贯 法输注环泊酚维持量。当警觉/镇静观察（OAA/S）评分 ≤ 1分且脑电双频指数（BIS）值 < 60时开始手术，当患者发生 体动反应时，追加环泊酚 0.1 mg/kg。记录所有患者体动反应情况，以及诱导前（T0）、诱导完成即刻（T1）、诱导完成 后3 min（T2）、置入宫腔镜时（T3）、苏醒时（T4）的心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）、呼吸频率（RR） 及BIS值。评估并记录不良反应的发生情况，包括呼吸抑制、心动过缓、低血压等。采用 Probit 回归分析计算半数 有效剂量（ED50）、95% 有效剂量（ED95）及 95%CI。结果 B 组的阿芬太尼呈剂量依赖性降低环泊酚抑制患者体 动反应的 50% 有效剂量（ED50）及 95%CI为 1.35（1.09～1.70） mg/（kg·h），明显低于 A 组的 ED50及 95%CI的 1.68 （1.42~2.07） mg/（kg·h），差异有统计学意义（P < 0.05）。与A组比较，B组的苏醒时间明显缩短（P < 0.05）。两组患 者 MAP、HR、RR、意识消失时间以及不良反应组间比较差异无统计学意义（P > 0.05）。结论 环泊酚复合 40 μg/L 阿芬太尼麻醉苏醒时间更短，更安全有效。

Abstract:

Abstract: Objective To investigate the optimal dosage of ciprofol combined with different plasma targetcontrolled concentrations of alfentanil to inhibit body movement response in patients undergoing hysteroscopic treatment. Methods Forty patients undergoing selective non-intubated intravenous general anesthesia for hysteroscopic treatment at Foshan Fuxing Chancheng Hospital from August 2023 to October 2023 were randomly divided into two groups: ciprofol combined with 20 μg/L alfentanil group (Group A) and ciprofol combined with 40 μg/L alfentanil group (Group B), with 20 patients in each group. Upon the patient's entry into the operating room, plasma target-controlled infusion (TCI) of alfentanil is initiated. Once the target concentration reached equilibrium with the effect compartment target concentration, ciprofol induction dose of 0.35 mg/kg was administered, followed by sequential administration of ciprofol maintenance dose by adopting sequential experimental method. Surgery was initiated when the Alert/Sedation Observation Score for the target patent was ≤1 and the bispectral index value was <60. When patients exhibited body movement response, an additional 0.1 mg/kg of ciprofol was administered. All patients' body movement response situations, as well as heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO2), respiratory rate (RR), and bispectral index values (BIS) at induction before (T0), immediately after induction (T1), 3 minutes after induction (T2), during hysteroscopy insertion (T3), and at awakening (T4) were recorded. Adverse reactions, including respiratory depression, bradycardia, and hypotension, were assessed and recorded. The Probit regression analysis was used to calculate the median effective dose (ED50), 95% effective dose (ED95), and 95% confidence interval (CI). Results The alfentanil in Group B showed a dose-dependent reduction in the 50% effective dose (ED50) of ciprofol to inhibit patient somatic response, with an ED50 and 95% CI of 1.35 (1.09-1.70) mg/(kg·h), significantly lower than the ED50 and 95% CI of 1.68 (1.42-2.07) mg/(kg·h) in Group A, with a statistically significant difference (P < 0.05).compared with Group A, the wake-up time in Group B was significantly shorter (P < 0.05). There were no significant differences in MAP, HR, RR, time to loss of consciousness, or adverse reactions between the two groups (P > 0.05). Conclusion The combination of ciprofol with 40 μg/L alfentanil has a shorter wake-up time and is safer and more effective.