环泊酚与丙泊酚对老年高血压患者下肢手术麻醉诱导期血流动力学及炎症的影响 ^*

The effects of cyclophenol and propofol on hemodynamics and inflammation during anesthesia induction in elderly hypertensive patients undergoing lower limb surgery

摘要

目的 探讨环泊酚与丙泊酚对老年高血压患者下肢手术麻醉诱导期血流动力学及炎症指标的影响。方法 收集2023年3月—12月新疆维吾尔自治区人民医院收治的90例行下肢手术治疗的老年高血压患者进行回顾性队列研究, 根据麻醉诱导用药不同分为环泊酚组 (45例) 和丙泊酚组 (45例)。环泊酚组静脉给予环泊酚注射液0.4 mg/kg+苯磺顺阿曲库铵15 mg+舒芬太尼0.4 μg/kg进行麻醉诱导。丙泊酚组给予丙泊酚注射液1.5 mg/kg+苯磺顺阿曲库铵15 mg+舒芬太尼0.4 μg/kg进行麻醉诱导。观察两组的血流动力学指标、炎症指标、术后48 h内谵妄发生率和麻醉诱导期心动过缓、低血压等不良反应发生情况。结果 重复测量方差分析显示, 两组舒张压 (DBP)、收缩压 (SBP)、心率 (HR) 在组别、时间以及组间×时间交互作用比较, 差异均有统计学意义 (P<0.05)。进一步做单独效应分析, 组间比较发现, 诱导前两组DBP、SBP和HR比较, 差异均无统计学意义 (P>0.05); 麻醉诱导后2 min; 气管插管后1 min、3 min及5 min时, 环泊酚组DBP、SBP和HR均低于丙泊酚组 (P<0.05)。组内比较发现, 两组DBP、SBP和HR均随手术时间进行呈现出先上升后下降的趋势 (P<0.05), 在气管插管后3 min开始呈下降趋势。经单因素方差分析显示, 环泊酚组和丙泊酚组不同时间点DBP、SBP和HR比较差异均有统计学意义 (P<0.05)。术后24 h, 两组中性粒细胞与淋巴细胞比值 (NLR)、血小板与淋巴细胞比值 (PLR)、C反应蛋白 (CRP) 和红细胞沉降率 (ESR) 均较术前升高 (P<0.05), 但环泊酚组NLR、PLR、CRP、ESR水平均低于丙泊酚组 (P<0.05)。术后48 h内, 环泊酚组谵妄发生率低于丙泊酚组 (4.44%和17.78%, P<0.05)。麻醉诱导期间, 两组不良反应发生率比较, 差异均无统计学意义 (P>0.05)。结论 老年高血压患者在下肢手术中应用环泊酚进行麻醉诱导, 能更好地稳定血流动力学, 减轻机体炎症反应, 预防谵妄发生, 且不增加不良反应发生。

Abstract

Objective To investigate the effects of cyclophenol and propofol on hemodynamic and inflammatory indicators during anesthesia induction in elderly patients with hypertension undergoing lower limb surgery. Methods A retrospective cohort study was conducted on 90 elderly patients with hypertension who underwent lower limb surgery at People's Hospital of Xinjiang Uygur Autonomous Region from March to December 2023. The patients were divided into a propofol group (45 cases) and a cyclophenol group (45 cases) according to different anesthesia induction drugs. The ciclosporin group received intravenous ciclosporin injection 0.4 mg/kg + cisatracurium besilate 15 mg + sufentanil 0.4 μg/kg for anesthesia induction. At the same time, the propofol group received propofol injection 1.5 mg/kg + cisatracurium besilate 15 mg + sufentanil 0.4 μg/kg for anesthesia induction. The hemodynamic indexes, inflammatory indexes, the incidence of delirium within 48 h after operation and the incidence of adverse reactions such as bradycardia and hypotension during anesthesia induction were observed in the two groups. Results The repeated measures analysis of variance showed that there were statistically significant differences in diastolic blood pressure (DBP), systolic blood pressure (SBP), and heart rate (HR) between the two groups in terms of group, time point, and inter group and time interaction (P<0.05). Further analysis of individual effects revealed that there was no statistically significant difference in DBP, SBP, and HR between the two groups before induction anesthesia (P>0.05). At 2 min after induction anesthesia, and 1 min, 3 min, 5 min ofter tracheal intubation, the DBP, SBP, and HR of the cyclophenol group were lower than those of the propofol group (P<0.05). Within the group comparison, it was found that DBP, SBP, and HR in both groups showed a trend of first increasing and then decreasing with surgery time (P<0.05), and began to decrease at 3 min after induction anesthesia. According to one-way analysis of variance, DBP, SBP, and HR were compared between the propofol group and the propofol group at different time points, the differences were statistically significant (P<0.05). 24 hours after surgery, the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), C reactive protein (CRP), and erythrocyte sedimentation rate (ESR) in both groups increased compared to preoperative levels (P<0.05), but the NLR, PLR, CRP, and ESR levels in the cyclophenol group were lower than those in the propofol group (P<0.05). Within 48 hours after surgery, the incidence of delirium in the propofol group was lower than that in the propofol group (4.44% and 17.78%, P<0.05). During the anesthesia induction period, there was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion The use of cyclophenol for anesthesia induction in elderly hypertensive patients undergoing lower limb surgery can better stabilize hemodynamics, reduce inflammatory reactions, prevent delirium, and not increase the incidence of adverse reactions.

关键词

环泊酚 / 丙泊酚 / 高血压 / 麻醉诱导 / 血流动力学 / 炎症

Key words

Cyclophenol / Propofol / Hypertension / Anesthesia induction / Hemodynamics / Inflammation

参考文献

[1] Wang Z Y , Li J , Wang A Q , et al. Effects of subanesthetic dose of esketamine on hemodynamics and stress response in elderly patients undergoing knee replacement surgery during anesthesia induction[J]. Chin J Pract Diagn Ther, 2022, 36(1): 88-92.

[2] 王泽宇, 李娟, 王爱群, 等 . 亚麻醉剂量艾司氯胺酮对老年膝关节置换术患者麻醉诱导期血流动力学和应激反应的影响[J]. 中华实用诊断与治疗杂志, 2022, 36(1): 88-92.

[3] Yang R, Zhao D, Zhang X, et al. Comparison of sevoflurane and propofol on the incidence of postoperative pain and quality of life in patients undergoing total knee arthroplasty with chronic pain before surgery[J]. Pain Pract, 2021, 21(1): 37-44.

[4] 彭罗方, 陈旦, 汪同旋, 等 . 丙泊酚闭环靶控输注下不同麻醉深度控制水平复合神经阻滞在老年人工髋关节置换术中的应用[J]. 中国医师杂志, 2021, 23(11): 1677-1681.

[5] Peng L F , Chen D , Wang T X , et al. Application of different levels of propofol closed—loop target—controlled infusion combined with nerve block in elderly patients undergoing total hip arthroplasty[J]. J Chin Physician, 2021, 23(11): 1677-1681.

[6] Liang P, Dai M, Wang X, et al. Efficacy and safety of ciprofol vs. propofol for the induction and maintenance of general anaesthesia: a multicentre, single—blind, randomised, parallel—group, phase 3 clinical trial[J]. Eur J Anaesthesiol, 2023, 40(6): 399-406.

[7] 《中国高血压防治指南》修订委员会 . 中国高血压防治指南2018年修订版[J]. 心脑血管病防治, 2019, 19(1): 1-44.

[8] The Revision Committee of the Chinese Guidelines for the Prevention and Treatment of Hypertension. Chinese guidelines for the prevention and treatment of hypertension 2018 revision[J]. J Prev Treat Cardio—Cerebrovasc Dis, 2019, 19(1): 1-44.

[9] 吴宇洁, 石中永, 王美娟, 等 . 记忆谵妄评定量表中文版测评老年术后患者的效度和信度[J]. 中国心理卫生杂志, 2014, 28(12): 937-941.

[10] Wu Y J , Shi Z Y , Wang M J , et al. Validity and reliability of the Chinese version of the Delirium Rating Scale for elderly postoperative patients[J]. Chin Ment Health J, 2014, 28(12): 937-941.

[11] 熊言顺, 疏树华, 王迪, 等 . 右美托咪定复合尼卡地平在全身麻醉老年高血压患者全膝关节置换术的应用研究[J]. 重庆医学, 2022, 51(6): 924-928.

[12] Xiong Y S , Shu S H , Wang D , et al. Application of dexmedetomidine combined with nicardipine in total knee arthroplasty for elderly hypertensive patients under general anesthesia[J]. Chongqing Med J, 2022, 51(6): 924-928.

[13] 刘秀叶, 郭琼梅, 王莉, 等 . 右美托咪定抑制老年高血压患者下肢手术止血带相关高血压的临床研究[J]. 河北医药, 2021, 43(21): 3258-3261.

[14] Liu X Y , Guo Q M , Wang L , et al. Clinical study on the effect of dexmedetomidine in inhibiting tourniquet—induced hypertension in elderly hypertensive patients undergoing lower limb surgery[J]. Hebei Med J, 2021, 43(21): 3258-3261.

[15] 冯燕春, 黄格, 阮浩神, 等 . 瑞芬太尼复合依托咪酯和丙泊酚闭环靶诱导用于合并高血压的全麻气管插管患者效果观察[J]. 山东医药, 2021, 61(22): 54-56.

[16] Feng Y C , Huang G , Ruan H S , et al. Observation on the effect of remifentanil combined with etomidate and propofol closed—loop target induction in patients with hypertension undergoing general anesthesia for tracheal intubation[J]. Shandong Med J, 2021, 61(22): 54-56.

[17] 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.

[18] Liu Y, Peng Z, Liu S, et al. Efficacy and safety of ciprofol sedation in icu patients undergoing mechanical ventilation: a multicenter, single—blind, randomized, noninferiority trial[J]. Crit Care Med, 2023, 51(10): 1318-1327.

[19] 易强林, 莫怀忠, 胡慧, 等 . 环泊酚与丙泊酚在老年患者无痛胃镜检查中的比较[J]. 临床麻醉学杂志, 2022, 38(7): 712-715.

[20] Yi Q L , Mo H Z , Hu H , et al. Comparison of ring—hexane and propofol in painless gastroscopy for elderly patients[J]. J Clin Anesthesiol, 2022, 38(7): 712-715.

[21] 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.

[22] Expert Panel on Clinical Application of Ring—Hexane . Expert opinions on the clinical application of ring—hexane (2023)[J]. Chin J Anesthesiol, 2023, 43(7): 769-772.

[23] 陈靖, 朱芸燕, 张传武, 等 . 环泊酚在临床麻醉中的应用研究进展[J]. 国际麻醉学与复苏杂志, 2023, 44(10): 1111-1115.

[24] Chen J , Zhu Y Y , Zhang C W , et al. Research progress on the application of ring—hexane in clinical anesthesia[J]. Int J Anesth Resuscit, 2023, 44(10): 1111-1115.

[25] 曾琼, 金晶星, 李锦汶, 等 . 环泊酚用于帕金森患者全麻脑深部刺激器植入术的临床观察[J]. 临床神经外科杂志, 2023, 20(1): 62-66.

[26] Zeng Q , Jin J X , Li J W , et al. Clinical observation of ring—hexane in Parkinson's disease patients undergoing general anesthesia for deep brain stimulator implantation[J]. J Clin Neurosurg, 2023, 20(1): 62-66.

[27] 张锌, 赵王成, 路文浩 . 右美托咪定对老年患者髋部手术后认知功能及氧化应激与炎症反应的影响[J]. 宁夏医科大学学报, 2021, 43(3): 256-260.

[28] Zhang X , Zhao W C , Lu W H . Effects of dexmedetomidine on cognitive function and oxidative stress and inflammatory responses in elderly patients after hip surgery[J]. J Ningxia Med Univ, 2021, 43(3): 256-260.

[29] 付慧敏, 钟超超, 周伟伟, 等 . 急性等容血液稀释对老年患者全髋关节置换术后谵妄和炎症水平的影响[J]. 临床麻醉学杂志, 2021, 37(6): 583-587.

[30] Fu H M , Zhong C C , Zhou W W , et al. Effects of acute normovolemic hemodilution on postoperative delirium and inflammatory levels in elderly patients undergoing total hip arthroplasty[J]. J Clin Anesth, 2021, 37(6): 583-587.

[31] 谈大海, 沈建秋, 张帆, 等 . 右美托咪定或丙泊酚对老年患者腰硬联合阻滞术后认知功能的影响[J]. 中国新药与临床杂志, 2020, 39(6): 363-366.

[32] Tan D H , Shen J Q , Zhang F , et al. Effects of dexmedetomidine or propofol on cognitive function in elderly patients after spinal—epidural combined anesthesia[J]. Chin. J. New Drugs Clin. Remedies, 2020, 39(6): 363-366.

[33] 李玲瑶, 李术榕, 李响, 等 . 环泊酚临床应用现状及研究进展[J]. 心肺血管病杂志, 2023, 42(1): 97-99.

[34] Li L Y , Li S R , Li X , et al. Current status and research progress of the clinical application of ring—hexane[J]. J Cardiovasc Pulm Dis, 2023, 42(1): 97-99.

[35] 吴金龙, 许敏, 王莉珍, 等 . 环泊酚与丙泊酚对髋关节置换术患者围术期炎症指标和术后恢复情况的影响[J]. 中国临床保健杂志, 2023, 26(4): 556-559.

[36] Wu J L , Xu M , Wang L Z , et al. Effects of ring—hexane and propofol on perioperative inflammatory markers and postoperative recovery in patients undergoing hip replacement surgery[J]. Chin J Clin Healthc, 2023, 26(4): 556-559.

[37] Liu X, Ren M, Zhang A, et al. Nrf2 attenuates oxidative stress to mediate the protective effect of ciprofol against cerebral ischemia—reperfusion injury[J]. Funct Integr Genomics, 2023, 23(4): 345.

[38] 谭正玲, 彭姝嫕, 胡志强, 等 . 环泊酚用于肥胖患者宫腔镜手术麻醉的安全性及有效性[J]. 广东医学, 2023, 44(4): 462-466.

[39] Tan Z L , Peng S Y , Hu Z Q , et al. Safety and efficacy of ring—hexane for anesthesia in obese patients undergoing hysteroscopy[J]. Guangdong Med J, 2023, 44(4): 462-466.

[40] Yang D, Zhang W, Ruan Z, et al. Drug—drug interaction study of ciprofol and sodium divalproex: pharmacokinetics, pharmacodynamics, and safety in healthy Chinese subjects[J]. Clin Transl Sci, 2023, 16(10): 1972-1981.

基金资助

^*新疆维吾尔自治区重点研发计划项目(2022B03009-4)