环泊酚对胸腔镜肺癌根治术老年患者术后谵妄及早期康复的影响
Effects of ciprofol on postoperative delirium and early rehabilitation in elderly patients undergoing thoracoscopic radical resection of lung cancer
奚高原 1曹秀丽 1周俊辉1
作者信息
- 1. 河南省胸科医院,郑州大学附属胸科医院麻醉科,郑州 450000
- 折叠
摘要
目的 探讨环泊酚用于全身麻醉诱导和维持对胸腔镜肺癌根治术老年患者术后谵妄(postoperative delirium,POD)及早期康复的影响.方法 河南省胸科医院于2023年5月至2024年2月招募年龄在65至79岁的老年患者220例,计划行胸腔镜肺癌根治术.使用随机数字表将这220例患者随机分为两组:环泊酚组(C组)和丙泊酚组(P组),每组110例.C组麻醉诱导时静脉注射环泊酚0.3 mg/kg,麻醉维持时静脉输注环泊酚0.6～1.8 mg/(kg·h);P组麻醉诱导时静脉注射丙泊酚2.0 mg/kg,麻醉维持时静脉输注丙泊酚4.0～12.0 mg/(kg·h).两组其余的麻醉诱导和维持用药均一致.术后3 d内将使用重症监护室(ICU)的意识障碍评估法(CAM-ICU)来评估患者POD的发生情况.使用15项恢复质量问卷(QoR-15)在术后1 d和2d时评估恢复质量.统计和分析首次下地活动时间及住院时间、术前及术后1 d、3 d时的血常规以及术中及术后并发症即窦性心动过缓、低血压、高血压及术后感染等发生情况.结果 在术后3 d内,C组和P组患者中分别有19例(17.3％)和35例(31.8％)发生了 POD,而有91例(82.7％)和75例(68.2％)未发生POD.研究结果显示,C组POD发生率显著低于P组(P＜0.05).相较于P组,C组患者术后1 d和2 d时的QoR-15评分均有显著提高(P＜0.05),同时首次下地活动时间明显缩短(P＜0.05).此外,C组术后1 d、3d时的白细胞计数、中性粒细胞计数和中性粒细胞百分比呈显著下降趋势(P＜0.05),术中窦性心动过缓和低血压的发生率在C组中也显著降低(P＜0.05).结论 与丙泊酚比较,环泊酚可降低胸腔镜肺癌根治术老年患者POD发生率,且可改善早期临床预后.
Abstract
Objective To investigate the effects of ciprofol for induction and maintenance of general anesthesia on post-operative delirium(POD)and early rehabilitation in elderly patients undergoing thoracoscopic radical resection of lung cancer.Methods Henan Provincial Chest Hospital recruited 220 elderly patients aged 65 to 79 for planned thoracoscop-ic lung cancer radical surgery from May 2023 to February 2024.These 220 patients were randomly allocated into two groups using a random number table:propofol group(group C)and ciprofol group(group P),with each group consis-ting of 110 cases.Ciprofol 0.3 mg/kg was injected intravenously during anesthesia induction in the group C,and cipro-fol 0.6-1.8 mg/(kg·h)was pumped intravenously during anesthesia maintenance;the patients of the group P was in-travenously injected with propofol 2.0 mg/kg during anesthesia induction,and intravenous infusion of propofol 4.0-12.0 mg/(kg·h)was administrating during anesthesia maintenance.The rest of the anesthesia induction and maintenance medication were the same between the two groups.The occurrence of POD within 3 d after surgery was assessed using the confusion assessment method for the intensive care unit(CAM-ICU).The quality of recovery was assessed on the first and second postoperative day using the 15-item quality of recovery questionnaire(QoR-15).The time of first ambulation and postoperative hospital stay,blood routine before operation and on 1 d and 3 d after operation,and the incidence of intraoperative and postoperative complications inclu-ding sinus bradycardia or hypotension/hypertension and postoperative infection were statistically analyzed.Results Within 3 d after operation,POD occurred in 19 patients(17.3％)and 35 patients(31.8％)in group C and group P,respectively,while POD did not occur in 91 patients(82.7％)and 75 patients(68.2％).The study results showed that the incidence of POD in group C was significantly lower than that in group P(P＜0.05).In compar-ison to the group P,patients in the group C showed significantly increased QoR-15 scores on 1 d and 2 d postoperative-ly(P＜0.05),along with a notable reduction in time to first ambulation(P＜0.05).Additionally,the group C exhibi-ted a significant decrease in white blood cell count,neutrophil count,and percentage of neutrophils on 1 d and 3 d after surgery(P＜0.05).The incidence of sinus bradycardia and hypotension during surgery was also significantly lower in the group C(P＜0.05).Conclusion Compared with propofol,ciprofol for induction and maintenance of general anes-thesia does not increase the incidence of POD in elderly patients undergoing thoracoscopic radical resection of lung canc-er,and improve early clinical outcomes.
关键词
环泊酚/术后谵妄/胸外科手术/老年人Key words
Ciprofol/Postoperative delirium/Thoracic surgery/Elderly引用本文复制引用
基金项目
河南省2021年科技发展计划项目(212102310720)
河南省2023年科技研发计划联合基金资助项目(232103810054)
出版年
2024
NETL
NSTL
万方数据