复合阿芬太尼时环泊酚用于不同BMI患者胃镜检查术麻醉效力的比较  

Comparison of anesthetic potency of ciprofol combined with alfentanil in patients with different BMIs during gastroscopy

作　　者：黄瑾 张珈硕 王晟昱 韩亚楠 姜卜维 马凤丹 王春光[1] Huang Jin;Zhang Jiashuo;Wang Shengyu;Han Yanan;Jiang Bowei;Ma Fengdan;Wang Chunguang(Department of Anesthesiology,Baoding First Central Hospital,Baoding 071000,China)

机构地区：[1]保定市第一中心医院麻醉科,保定071000

出　　处：《中华麻醉学杂志》2024年第12期1476-1479,共4页Chinese Journal of Anesthesiology

摘　　要：目的比较复合阿芬太尼时环泊酚用于不同BMI患者无痛胃镜检查术的麻醉效力。方法选取保定市第一中心医院2023年10月至12月择期行无痛胃镜检查术患者,年龄18~64岁,BMI 18~36 kg/m^(2),ASA分级Ⅰ或Ⅱ级,根据患者BMI分为3组:体质量正常组(18 kg/m^(2)≤BMI<24 kg/m^(2))、超重组(24 kg/m^(2)≤BMI<28 kg/m^(2))和肥胖组(BMI≥28 kg/m^(2))。采用抛偏倚硬币设计(BCD)法确定无痛胃镜检查中环泊酚95%有效剂量(ED 95)。静脉注射阿芬太尼5μg/kg和环泊酚行麻醉诱导,待患者睫毛反射消失、下颌松弛、改良警觉/镇静评分≤1分后进行胃镜检查术。环泊酚初始剂量0.2 mg/kg,剂量梯度为0.04 mg/kg,若注射环泊酚3 min后改良警觉/镇静评分仍>1分或进镜时患者出现体动、呛咳、吞咽等影响操作的反应为阳性反应,否则为阴性反应。若发生阳性反应,下一例患者升高一个剂量梯度;若发生阴性反应,下一例患者95%的概率接受相同剂量,5%的概率接受降低一个剂量梯度的剂量,直至完成40例。结果体质量正常组、超重组、肥胖组环泊酚ED 95(95%置信区间)分别为0.266(0.246~0.285)mg/kg、0.218(0.189~0.244)mg/kg、0.191(0.156~0.220)mg/kg,超重组和肥胖组环泊酚ED 95低于体质量正常组(P<0.05)。结论超重和肥胖可增加胃镜检查术患者环泊酚的麻醉效力。Objective To compare the anesthetic potency of ciprofol combined with alfentanil in patients with different body mass indexes(BMIs)during gastroscopy.MethodsAmerican Society of Anesthesiologists Physical Status classification I orⅡpatients,aged 18-64 yr,with a BMI of 18-36 kg/m^(2),undergoing elective painless gastroscopy at Baoding First Central Hospital from October to December 2023,were divided into 3 groups:normal group(18 kg/m^(2)≤BMI<24 kg/m^(2)),overweight group(24 kg/m^(2)≤BMI<28 kg/m^(2))and obesity group(BMI≥28 kg/m^(2)).The 95%effective dose(ED 95)of ciprofol during painless gastroscopy was determined by the biased coin design.Alfentanyl 5μg/kg and ciprofol were intravenously injected for anesthesia induction.Gastroscopy was performed after the patient′s eyelash reflex disappeared,the jaw muscle was relaxed and the Modified Observer′s Assessment of Alertness/Sedation Scale score≤1.The initial dose of ciprofol was 0.2 mg/kg with a dose gradient of 0.04 mg/kg.The positive response were defined as the Modified Observer′s Assessment of Alertness/Sedation Scale score still>1 after 3 min of ciprofol injection or any other responses affecting the procedure,such as body movement,bucking,or swallowing during insertion of the endoscope.If the response was positive,the next patient received a higher dose of ciprofol,or conversely if negative,the next patient received the same dose(95%probability)or a lower dose(5%probability).Each group was completed with 40 cases.ResultsThe ED 95 and 95%confidence intervals of ciprofol in normal,overweight and obese groups were 0.266(0.246,0.285)mg/kg,0.218(0.189,0.244)mg/kg,0.191(0.156,0.220)mg/kg,respectively.The ED 95 of ciprofol was significantly lower in overweight and obese groups than in normal group(P<0.05).ConclusionsOverweight and obesity can increase the anesthetic potency of ciprofol in patients undergoing gastroscopy.

关 键 词：体重变化 环泊酚 阿芬太尼 胃镜检查 剂量效应关系 药物 

分 类 号：R61[医药卫生—外科学]