环泊酚与丙泊酚用于胸腔镜肺癌肺叶切除术麻醉诱导的血流动力学及术后恢复比较

doi:10.3877/cma.j.issn.1674-6902.2026.03.011

目的

分析环泊酚与丙泊酚对电视胸腔镜(video-assisted thoracoscopic surgery, VATS)肺癌肺叶切除术麻醉诱导和维持期血流动力学及术后恢复的影响。

方法

选择2024年1月至2025年12月我院收治的接受VATS肺段切除或肺叶切除手术患者173例，根据麻醉方法不同分为丙泊酚组95例和环泊酚组78例。丙泊酚组脑电双频指数(bispectral index, BIS)监测下靶控输注丙泊酚1.5~2.5 mg/kg麻醉诱导和4~12 mg/(kg·h)麻醉维持；环泊酚组靶控输注环泊酚0.4~0.5 mg/kg麻醉诱导和0.4~2.4 mg/(kg·h)麻醉维持。分析术中生命体征、术后恢复和安全性评价。

结果

两组麻醉诱导成功率为100%。诱导阶段T₃~T₄两组BIS降至最低；维持阶段环泊酚组BIS在T₇~T₁₀低于丙泊酚组(P<0.05)。两组BIS 40~60占比(44.21%比24.36%，P＝0.007)及时间占比[79.67±24.81)%比(72.62±23.59)%，P＝0.059]差异无统计学意义。环泊酚组收缩压(systolic blood pressure, SBP)、舒张压(diastolic blood pressure, DBP)、平均动脉压(mean arterial pressure, MAP)下降幅度较丙泊酚组平缓(P＝0.028、0.044、<0.001)。环泊酚组QoR-15评分高于丙泊酚组[137.00(134.00，140.00)分比135.00(132.75，137.00)分，Z＝－2.359，P＝0.040]。两组术后RASS评分[4.00(3.00，4.00)分比4.00(3.00，4.00)分，P＝0.981]、T_ROC[(5.60±1.87 )min比(6.07±2.01) min，t＝1.579，P＝0.116)]、拔管时间[(4.15±2.05)d比(4.67±2.16)d，t＝1.620，P＝0.107]、NRS评分[2.41(1.81，2.24)分比2.93(1.87，2.70)分，P＝0.601]及术后恶心呕吐发生率(14.00%比18.00%，P＝0.585)差异无统计学意义。环泊酚组注射部位疼痛2~3级发生率低于丙泊酚组(11.54%比33.68%，χ²＝11.621，P＝0.001)，维持期间药物相关性低血压发生率低于丙泊酚组(7.69%比24.21%，χ²＝8.376，P＝0.004)；两组心动过缓(10.26%比13.68%)、心动过速(6.41%比13.68%)、血压升高(7.69%比11.58%)、插管反应(2.56%比6.32%)发生率差异无统计学意义(P>0.05)。

结论

环泊酚可用于VATS麻醉诱导和维持，麻醉效果及安全性不劣于丙泊酚，血流动力学稳定，注射部位疼痛2~3级、低血压等不良事件发生率低。

关键词: 支气管肺癌, 环泊酚, 丙泊酚, 电视胸腔镜手术, 血流动力学

Objective

To analyze the effects of ciprofol versus propofol on hemodynamics during anesthesia induction and maintenance and on postoperative recovery in video-assisted thoracoscopic surgery (VATS) lobectomy.

Methods

A total of 173 patients who underwent VATS segmentectomy or lobectomy in our hospital from January 2024 to December 2025 were selected. 95 patients were assigned to the propofol group and 78 to the ciprofol group. In the propofol group, anesthesia was induced with target-controlled infusion (TCI) of propofol 1.5~2.5 mg/kg and maintained with 4~12 mg/(kg·h) under bispectral index (BIS) monitoring. In the ciprofol group, anesthesia was induced with TCI of ciprofol 0.4~0.5 mg/kg and maintained with 0.4~2.4 mg/(kg·h). Intraoperative vital signs, postoperative recovery, and safety were evaluated.

Results

The success rate of anesthesia induction was 100% in both groups. At T₃-T₄ during induction, BIS values reached their nadir in both groups; during the maintenance phase, BIS in the ciprofol group was lower than that in the propofol group at T₇-T₁₀ (P<0.05). The proportion of time with bispectral index (BIS) ranging from 40 to 60 was 44.21% vs 24.36% (P=0.007), and the relative time proportion was (79.67±24.81)% vs (72.62±23.59)% (P=0.059); no statistically significant difference was observed between the two groups. Compared with the propofol group, the reductions in systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were milder in the ciprofol group (P=0.028, 0.044, <0.001). The QoR-15 score was higher in the ciprofol group than in the propofol group [137.00 (134.00, 140.00) vs 135.00 (132.75, 137.00), Z=-2.359, P=0.040]. There were no significant differences between the two groups in postoperative RASS score [4.00(3.00, 4.00) vs 4.00(3.00, 4.00), P=0.981], T_ROC [(5.60±1.87) min vs (6.07±2.01) min, t=1.579, P=0.116], extubation time [(4.15±2.05)d vs (4.67±2.16)d, t=1.620, P=0.107], Numerical Rating Scale (NRS) score [2.41(1.81, 2.24) vs 2.93(1.87, 2.70), P=0.601], and incidence of postoperative nausea and vomiting (14.00% vs 18.00%, P=0.585). The incidence of grade 2-3 injection site pain was lower in the ciprofol group (11.54% vs 33.68%, χ²=11.621, P=0.001), as was the incidence of drug-related hypotension during anesthesia maintenance (7.69% vs 24.21%, χ²=8.376, P=0.004). No significant between-group differences were found in the incidences of bradycardia (10.26% vs 13.68%), tachycardia (6.41% vs 13.68%), hypertension (7.69% vs 11.58%) and intubation response (2.56% vs 6.32%) (P>0.05).

Conclusion

Ciprofol can be used for anesthesia induction and maintenance in VATS, with efficacy and safety non-inferior to propofol. It provides more stable hemodynamics and is associated with lower incidences of grade 2~3 injection site pain and hypotension.

Key words: Bronchogenic carcinoma, Ciprofol, Propofol, Video-assisted thoracoscopic surgery, Hemodynamics

图1 患者筛选和入组流程图

表1 两组VATS肺手术患者临床资料结果

临床资料	丙泊酚组(n＝95)	环泊酚组(n＝78)	t/χ²值	P值
身高[cm，(±s)]	163.74±8.94	164.86±9.49	0.943	0.347
体质量[kg，(±s)]	61.53±12.02	61.69±12.02	0.104	0.917
合并症[n(%)]
高血压	40(42.11)	41(52.56)	1.882	0.170
糖尿病	13(13.68)	14(17.95)	0.591	0.442
ASA身体状况[n(%)]			0.172	0.678
Ⅱ级	87(91.58)	70(89.74)
Ⅲ级	8(8.42)	8(10.26)
手术类型[n(%)]			0.238	0.626
肺段切除术	45(47.37)	38(48.72)
肺叶切除术	50(52.63)	40(51.28)
麻醉期(±s)
诱导用药剂量(mg/kg)	2.17±0.07	0.43±0.01	217.600	0.000
维持起始输注速率[mg/(kg·h)]	5.02±0.09	0.82±0.04	382.200	0.000
维持最大输注速率[mg/(kg·h)]	6.74±1.73	1.12±0.27	28.390	0.000
剂量调整次数>2次[n(%)]	51(53.68)	33(42.31)	2.219	0.136

表1 两组VATS肺手术患者临床资料结果

临床资料	丙泊酚组(n＝95)	环泊酚组(n＝78)	t/χ²值	P值
身高[cm，(±s)]	163.74±8.94	164.86±9.49	0.943	0.347
体质量[kg，(±s)]	61.53±12.02	61.69±12.02	0.104	0.917
合并症[n(%)]
高血压	40(42.11)	41(52.56)	1.882	0.170
糖尿病	13(13.68)	14(17.95)	0.591	0.442
ASA身体状况[n(%)]			0.172	0.678
Ⅱ级	87(91.58)	70(89.74)
Ⅲ级	8(8.42)	8(10.26)
手术类型[n(%)]			0.238	0.626
肺段切除术	45(47.37)	38(48.72)
肺叶切除术	50(52.63)	40(51.28)
麻醉期(±s)
诱导用药剂量(mg/kg)	2.17±0.07	0.43±0.01	217.600	0.000
维持起始输注速率[mg/(kg·h)]	5.02±0.09	0.82±0.04	382.200	0.000
维持最大输注速率[mg/(kg·h)]	6.74±1.73	1.12±0.27	28.390	0.000
剂量调整次数>2次[n(%)]	51(53.68)	33(42.31)	2.219	0.136

表2 两组肺癌患者肿瘤标志物结果(

±s)

肿瘤标志物	丙泊酚组(n＝95)	环泊酚组(n＝78)	t/χ²值	P值
CEA(ng/ml)	3.20±0.42	3.23±0.45	0.453	0.651
CA125(U/ml)	16.02±1.73	15.95±1.80	0.260	0.795
CYFRA21-1(ng/ml)	3.24±0.46	3.22±0.51	0.271	0.787
NSE(ng/ml)	16.79±1.69	16.82±1.81	0.113	0.911

表2 两组肺癌患者肿瘤标志物结果(

±s)

肿瘤标志物	丙泊酚组(n＝95)	环泊酚组(n＝78)	t/χ²值	P值
CEA(ng/ml)	3.20±0.42	3.23±0.45	0.453	0.651
CA125(U/ml)	16.02±1.73	15.95±1.80	0.260	0.795
CYFRA21-1(ng/ml)	3.24±0.46	3.22±0.51	0.271	0.787
NSE(ng/ml)	16.79±1.69	16.82±1.81	0.113	0.911

图2 肺浸润性腺癌组织苏木精-伊红染色病理切片(×200)。图A为丙泊酚组中分化；图B为丙泊酚组低分化；图C为环泊酚组低分化；图D为环泊酚组中分化

表3 两组VATS肺手术患者BIS变化结果(

±s)

时　相	丙泊酚组(n＝95)	环泊酚组(n＝78)	t值	P值
T₁	96.28±3.87	95.12±4.75	1.312	0.191
T₂	86.00±11.67	84.16±13.41	0.965	0.336
T₃	48.60±8.35	49.10±7.27	0.415	0.679
T₄	42.70±6.60	43.54±8.65	0.724	0.470
T₅	44.52±9.73	44.56±8.73	0.028	0.978
T₆	46.98±7.85	46.52±6.76	0.408	0.684
T₇	52.50±7.59	49.36±6.13	2.948	0.004
T₈	57.68±6.48	53.52±6.69	4.141	0.000
T₉	60.46±5.37	55.74±5.16	5.854	0.000
T₁₀	62.32±4.13	57.48±5.22	6.808	0.000

表3 两组VATS肺手术患者BIS变化结果(

±s)

时　相	丙泊酚组(n＝95)	环泊酚组(n＝78)	t值	P值
T₁	96.28±3.87	95.12±4.75	1.312	0.191
T₂	86.00±11.67	84.16±13.41	0.965	0.336
T₃	48.60±8.35	49.10±7.27	0.415	0.679
T₄	42.70±6.60	43.54±8.65	0.724	0.470
T₅	44.52±9.73	44.56±8.73	0.028	0.978
T₆	46.98±7.85	46.52±6.76	0.408	0.684
T₇	52.50±7.59	49.36±6.13	2.948	0.004
T₈	57.68±6.48	53.52±6.69	4.141	0.000
T₉	60.46±5.37	55.74±5.16	5.854	0.000
T₁₀	62.32±4.13	57.48±5.22	6.808	0.000

图3 两组患者麻醉诱导和维持阶段血流动力学参数变化注：a为P<0.05；b为P<0.01；c为P<0.001；SBP为收缩压；DBP为舒张压；MAP为平均动脉压；HR为心率；T₁为入室时、T₂为诱导即刻、T₃为诱导后3 min、T₄为插管后即刻、T₅为插管5 min后、T₆为使用纤维支气管镜进行定位时，T₇为手术开始时，T₈为手术切皮后5 min、T₉为手术切皮后30 min、T₁₀为手术结束时

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Comparison of hemodynamics and postoperative recovery between ciprofol and propofol for anesthesia induction in thoracoscopic lobectomy for lung cancer

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Comparison of hemodynamics and postoperative recovery between ciprofol and propofol for anesthesia induction in thoracoscopic lobectomy for lung cancer