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

中国临床药理学与治疗学 ›› 2025, Vol. 30 ›› Issue (8): 1092-1098.doi: 10.12092/j.issn.1009-2501.2025.08.010

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

陆方舟¹, 刘美娟¹, 曾琼¹, 章文斌², 陆军¹

¹南京医科大学附属脑科医院麻醉科,南京 210029,江苏;
²南京医科大学附属脑科医院功能神经外科,南京 210029,江苏

收稿日期:2024-08-17 修回日期:2024-10-02 出版日期:2025-08-26 发布日期:2025-08-12
通讯作者: 陆军,男,副主任医师,主要从事神经外科危重症的麻醉与研究。E-mail： 13851507850@163.com
作者简介:陆方舟,女,硕士,住院医师,主要从事神经外科的麻醉研究。E-mail： 1592008753@qq.com
基金资助:
江苏省重点研发计划项目（BE2022049）; 江苏省重点研发计划产业前瞻与关键技术项目课题（BE2022049-1）

The median effective dose of ciprofol combined with sufentanil to inhibit tracheal intubation reaction in patients undergoing intracranial aneurysm embolization

LU Fangzhou, LIU Meijuan, ZENG Qiong, ZHANG Wenbin, LU Jun

¹Department of Anesthesiology, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China;
²Department of Functional Neurosurgery, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China

Received:2024-08-17 Revised:2024-10-02 Online:2025-08-26 Published:2025-08-12

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.

参考文献 24

[1]	Kang H, Luo B, Liu J, et al. Mortality after treatment of intracranial aneurysms with the pipeline embolization device [J]. J Neurointerv Surg, 2022, 14(1): neurintsurg-2020-017002.
[2]	Etminan N, Rinkel GJ.Unruptured intracranial aneurysms: development, rupture and preventive management[J]. Nat Rev Neurol, 2016, 12(12): 699-713.
[3]	Paramsothy J, Gutlapalli SD, Ganipineni VDP, et al.Propofol in ICU settings: understanding and managing anti-arrhythmic, pro-arrhythmic effects, and propofol infusion syndrome[J]. Cureus, 2023, 15(6): e40456.
[4]	Lu Z, Zheng H, Chen Z, et al.Effect of etomidate vs propofol for total intravenous anesthesia on major postoperative complications in older patients: a randomized clinical trial[J]. JAMA Surg, 2022, 157(10): 888-895.
[5]	Feng Y, Liu J, Zhang WS.Etomidate-induced myoclonus correlates with the dysfunction of astrocytes and glutamate transporters in the neocortex of Sprague-Dawley rats[J]. Eur Rev Med Pharmacol Sci, 2022, 26(17): 6221-6235.
[6]	Chae D, Kim HC, Song Y, et al.Pharmacodynamic analysis of intravenous bolus remimazolam for loss of consciousness in patients undergoing general anaesthesia: a randomised, prospective, double-blind study[J]. Br J Anaesth, 2022, 129(1): 49-57.
[7]	Zhong J, Zhang J, Fan Y, et al.Efficacy and safety of Ciprofol for procedural sedation and anesthesia in non-operating room settings[J]. J Clin Anesth, 2023, 85: 111047.
[8]	尚平平, 刘晓宁, 范军朝. 环泊酚通过 Wnt/β-catenin 信号通路对帕金森病大鼠的神经保护作用[J]. 现代药物与临床, 2022, 37(3): 453-457.
[9]	Gao P, Jin Z, Wang P, et al.Effects of intracranial interventional embolization and intracranial clipping on the cognitive and neurologic function of patients with intracranial aneurysms[J]. Arch Clin Neuropsychol, 2022, 37(8): 1688-1698.
[10]	Rajbhandari PK.Lignocaine and esmolol on stress response to laryngoscopy and intubation[J]. JNMA J Nepal Med Assoc, 2014, 52(194): 775-779.
[11]	Vu EL, Brown CH 4th, Brady KM, et al. Monitoring of cerebral blood flow autoregulation: physiologic basis, measurement, and clinical implications[J]. Br J Anaesth, 2024, 132(6): 1260-1273.
[12]	Wang Y, Huang C, Tian R, et al.Target temperature management and therapeutic hypothermia in sever neuroprotection for traumatic brain injury: Clinic value and effect on oxidative stress[J]. Medicine (Baltimore), 2023, 102(10): e32921.
[13]	Whitehouse T, Hossain A, Perkins GD, et al.STRESS-L collaborators. landiolol and organ failure in patients with septic shock: the STRESS-L randomized clinical trial[J]. JAMA, 2023, 330(17): 1641-1652.
[14]	Ferraris A, Jacquet-Lagrèze M, Cazenave L, et al.Effects of landiolol on macrocirculatory parameters and left and right ventricular performances following cardiac surgery: a randomized controlled trial[J]. J Cardiothorac Vasc Anesth, 2022, 36(8 Pt B): 2864-2869.
[15]	Chae D, Kim HC, Song Y, et al.Pharmacodynamic analysis of intravenous bolus remimazolam for loss of consciousness in patients undergoing general anaesthesia: a randomised, prospective, double-blind study[J]. Br J Anaesth, 2022, 129(1): 49-57.
[16]	Oron AP, Souter MJ, Flournoy N.Understanding research methods: up-and-down designs for dose-finding[J]. Anesthesiology, 2022, 137(2): 137-150.
[17]	Xu Z, Lang Y, Xu X, et al.The ED50 and ED95 of esketamine for preventing early postoperative pain in patients undergoing laparoscopic cholecystectomy: a prospective, double-blinded trial[J]. BMC Anesthesiol, 2023, 23(1): 385.
[18]	Zhang J, Kong L, Ni J.ED50 and ED95 of propofol combined with different doses of intravenous lidocaine for first-trimester uterine aspiration: a prospective dose-finding study using up-and-down sequential allocation method[J]. Drug Des Devel Ther, 2022, 16: 3343-3352.
[19]	环泊酚临床应用指导意见专家小组. 环泊酚临床应用指导意见(2023)[J]. 中华麻醉学杂志, 2023, 43(7): 769-772.
[20]	Wang X, Wang X, Liu J, et al.Effects of ciprofol for the induction of general anesthesia in patients scheduled for elective surgery compared to propofol: a phase 3, multicenter, randomized, double-blind, comparative study[J]. Eur Rev Med Pharmacol Sci, 2022, 26(5): 1607-1617.
[21]	Lu M, Liu J, Wu X, et al.Ciprofol: a novel alternative to propofol in clinical intravenous anesthesia[J]. Biomed Res Int, 2023, 2023: 7443226.
[22]	马凤丹, 姜卜维, 黄瑾, 等. 复合依托咪酯时阿芬太尼抑制老年患者气管插管反应的半数有效剂量[J]. 临床麻醉学杂志, 2023, 39(9): 998-1000.
[23]	尤匡掌, 陈斌, 包倩倩. 七氟烷联合丙泊酚对老年非小细胞肺癌胸腔镜切除术后认知功能及血清氧化应激水平的影响[J]. 中国临床药理学与治疗学, 2017, 22(2): 190-193.
[24]	马垚, 李婷, 张秋实, 等. 60岁以上原发性肝癌患者术后谵妄发生风险预测模型的构建及验证[J]. 临床肝胆病杂志, 2024, 40(9): 1816-1821.

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

The median effective dose of ciprofol combined with sufentanil to inhibit tracheal intubation reaction in patients undergoing intracranial aneurysm embolization

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