【摘要】 目的 观察环泊酚注射液与丙泊酚注射液在老年患者膝关节置换术后镇痛中的麻醉效果及安全性。方法 将行膝关节置换术的老年患者按队列法分为对照组和试验组。对照组在麻醉诱导期静脉注射2.0 mg·kg^-1丙泊酚注射液，术中输注4.0～12.0 mg·kg^-1·h^-1丙泊酚注射液。试验组在麻醉诱导期静脉注射0.3 mg·kg^-1环泊酚注射液，术中持续输注0.4～2.4 mg·kg^-1·h^-1环泊酚注射液。比较2组患者的麻醉相关指标[诱导时间、麻醉术后恢复室（PACU）恢复时间、苏醒时间]、术后疼痛指标[用视觉模拟评分（VAS）评估]、血流动力学指标[心率（HR）、平均动脉压（MAP）]和应激反应指标[皮质醇（Cor）、去甲肾上腺素（NE）],并进行安全性评价。结果 试验组和对照组分别纳入38和37例患者。试验组和对照组的诱导时间分别为（73.32±13.19）和（52.96±10.54）s,在统计学上差异有统计学意义（P<0.05）。试验组和对照组的PACU恢复时间分别为（40.35±6.47）和（41.88±6.75）min,术后苏醒时间分别为（7.82±1.47）和（7.51±1.35）min,在统计学上差异均无统计学意义（均P>0.05）。术后24 h,试验组和对照组的VAS分别为（2.20±0.22）和（2.33±0.28）分，在统计学上差异有统计学意义（P<0.05）。术后即刻，试验组和对照组的HR分别为（73.55±8.12）和（79.14±8.83）beat·min^-1,MAP分别为（80.47±7.89）和（86.70±8.13）mmHg,在统计学上差异均有统计学意义（均P<0.05）。术后1 d,试验组和对照组的血清Cor水平分别为（605.99±82.46）和（661.32±89.40）nmol·L^-1,血清NE水平分别为（3.14±0.69）和（3.75±0.73）nmol·L^-1,在统计学上差异均有统计学意义（均P<0.05）。试验组的药物不良反应主要有低血压、术后谵妄和恶心呕吐，对照组的药物不良反应主要有低血压、术后谵妄、恶心呕吐、心动过缓和呼吸抑制。试验组和对照组的药物不良反应总发生率分别为18.42%和59.46%,在统计学上差异有统计学意义（P<0.05）。结论 相较于丙泊酚注射液，环泊酚注射液可以提高老年患者行膝关节置换的麻醉效果，改善术后疼痛，降低应激反应，降低药物不良反应的发生率，且对血流动力学的影响小。更多还原

【Abstract】 Objective To observe the anesthetic efficacy and safety of ciprofol injection and propofol injection in postoperative analgesia of elderly patients undergoing total knee arthroplasty.Methods According to cohort method,patients undergoing total knee arthroplasty were divided into control group and treatment group.The control group was given intravenous injection of 2.0 mg·kg^-1 propofol injection during anesthesia induction and intraoperative infusion of4.0-12.0 mg·kg^-1·h^-1 propofol injection,while treatment group was given intravenous injection of 0.3 mg·kg^-1ciprofol injection during anesthesia induction and intraoperative infusion of 0.4-2.4 mg·kg^-1·h^-1 ciprofol injection.The anesthesia-related indexes [induction time,recovery time in post-anesthesia care unit（PACU）,awaking time],postoperative pain [visual analogue scale（VAS）],hemodynamic indexes [heart rate（HR）,mean arterial pressure（MAP）] and stress response [cortisol（Cor）,norepinephrine（NE）] in the two groups were compared,and safety evaluation was performed.Results There were 38 patients in treatment group and 37 patients in control group,respectively.The induction time of treatment group and control group were（73.32±13.19） and（52.96±10.54） s,and the difference was statistically significant（P <0.05）.The recovery time of PACU and postoperative awaking time in treatment group and control group were [（40.35±6.47）,（41.88±6.75） min] and[（7.82±1.47）,（7.51±1.35） min],the difference was not statistically significant（all P>0.05）.At 24 h after surgery,VAS scores in treatment group and control group were（2.20±0.22） and（2.33±0.28） points,the difference was statistically significant（P <0.05）.Immediately after surgery,HR and MAP in treatment group and control group were [（73.55±8.12）,（79.14±8.83） beat·min^-1] and [（80.47±7.89）,（86.70±8.13）mmHg],the differences were statistically significant（all P <0.05）.At 1 d after surgery,levels of serum Cor and NE in treatment group and control group were [（605.99±82.46）,（661.32±89.40） nmol·L^-1] and[（3.14±0.69）,（3.75±0.73） nmol·L^-1],the differences were statistically significant（all P <0.05）.The main adverse drug reactions in treatment group were hypotension,postoperative delirium,nausea and vomiting,while those in control group were hypotension,postoperative delirium,nausea and vomiting,bradycardia and respiratory depression.The difference in total incidence of adverse drug reactions between treatment group and control group was statistically significant（18.42% vs 59.46%,P <0.05）.Conclusion Compared with propofol injection,ciprofol injection can improve anesthetic effect,alleviate postoperative pain,reduce stress response and incidence of adverse drug reactions in elderly patients after total knee arthroplasty,which has few effects on hemodynamics.更多还原