环泊酚复合舒芬太尼在颅内动脉瘤栓塞术患者中抑制气管插管反应的半数有效剂量

doi:10.12092/j.issn.1009-2501.2025.08.010

摘要/Abstract

摘要： 目的：探讨环泊酚复合舒芬太尼在颅内动脉瘤栓塞术患者中抑制气管插管反应的半数有效剂量（50% effective dose,ED₅₀）。方法：45例择期行颅内动脉瘤栓塞术的患者,按年龄分为两组：非老年组（年龄18~64岁）和老年组（年龄>65岁）。两组患者首先静注环泊酚,其中环泊酚初始剂量为0.4 mg/kg,根据脑电双频指数（BIS）值以及改良警觉/镇静评分（MOAA/S评分）依次静注舒芬太尼0.3 μg/kg、罗库溴铵0.6 mg/kg,气管插管统一定义为给予研究药物诱导后3 min。采用Dixon序贯法,根据气管插管是否为阳性反应[气管插管阳性反应定义为气管插管过程中患者出现呛咳等体动反应或插管后2 min内平均动脉压（MAP）或者心率（HR）升高幅度大于基础值的20%]来确定下一例患者使用环泊酚的剂量,当气管插管提示阳性,下一例患者升高一个浓度,反之则降低,研究以7个交叉为止。相邻患者的剂量公比为1∶1.1。采用 Probit 概率法计算环泊酚的ED₅₀、95%有效剂量（95% effective dose,ED₉₅）及相应95%置信区间（confidence interval,CI）。记录围术期两组患者的不良反应。结果：非老年组复合舒芬太尼时环泊酚抑制气管插管阳性反应的ED₅₀为0.472 mg/kg（95%CI 0.419~0.565 mg/kg）、ED₉₅为0.567 mg/kg（95%CI 0.513~1.293 mg/kg）;老年组复合舒芬太尼时环泊酚抑制阳性反应的ED₅₀为0.409 mg/kg（95%CI 0.383~0.434 mg/kg）、ED₉₅为0.452 mg/kg（95%CI 0.430~0.591 mg/kg）。结论：环泊酚复合舒芬太尼在非老年患者组以及在老年患者组抑制气管插管阳性反应的ED₅₀分别为0.472 mg/kg和0.409 mg/kg。

关键词: 环泊酚, 颅内动脉瘤, 舒芬太尼, 年龄, 插管反应

Abstract: AIM: To investigate the median effective dose of ciprofol combined with sufentanil to inhibit tracheal intubation reaction in patients undergoing intracranial aneurysm embolization. METHODS: Forty-five patients who underwent embolization for intracranial aneurysms were divided into two groups according to age: non-elderly group (aged 18-64 years) and elderly group (aged > 65 years). Patients in the two groups were first given intravenous ciprofol, of which the initial dose of ciprofol was 0.4 mg/kg and sufentanil 0.3 μg/kg and rocuronium 0.6 mg/kg were respectively injected according to BIS value and modified observer's assessment of alertness and sedation (MOAA/S) score. Then, endotracheal intubation was defined as 3 minutes after the induction of the study drug. Dixon sequential method was adopted, and the dose of ciprofol for the next patient was determined according to whether the tracheal intubation reaction was positive (Positive reaction of tracheal intubation was defined as the patient's kinomotor reaction such as coughing during tracheal intubation or the increase of MAP or HR within 2 minutes after intubation was greater than 20% of the basic value). When the tracheal intubation indicated a positive response, the next patient was raised by one gradient, otherwise, it was lowered by one gradient until the study ended at 7 crosses. The common dose ratio of adjacent patients was 1:1.1. The Probit probability method was used to calculate the 50% effective dose (ED₅₀), 95% effective dose (ED₉₅) and the corresponding 95% confidence interval (CI) of ciprofol. Perioperative adverse reactions were recorded in both groups. RESULTS: In the non-elderly group, the ED₅₀ of ciprofol inhibiting positive tracheal intubation reaction was 0.472 mg/kg (95%CI 0.419-0.565 mg/kg), and the ED₉₅ was 0.567 mg/kg (95%CI 0.513-1.293 mg/kg). In the elderly group, the ED₅₀ of ciprofol inhibiting tracheal intubation reaction was 0.409 mg/kg (95%CI 0.383-0.434 mg/kg) and the ED₉₅ was 0.452 mg/kg (95%CI 0.430-0.591 mg/kg). CONCLUSION: The ED₅₀ of ciprofol combined with sufentanil inhibiting positive tracheal intubation reaction was 0.472 mg/kg in non-elderly patients and 0.409 mg/kg in elderly patients.

Key words: ciprofol, intracranial aneurysm, sufentanil, age, intubation reaction

中图分类号:

R614

陆方舟, 刘美娟, 曾琼, 章文斌, 陆军. 环泊酚复合舒芬太尼在颅内动脉瘤栓塞术患者中抑制气管插管反应的半数有效剂量[J]. 中国临床药理学与治疗学, 2025, 30(8): 1092-1098.

LU Fangzhou¹, LIU Meijuan¹, ZENG Qiong¹, ZHANG Wenbin², LU Jun¹. The median effective dose of ciprofol combined with sufentanil to inhibit tracheal intubation reaction in patients undergoing intracranial aneurysm embolization[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2025, 30(8): 1092-1098.

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