达芬奇机器人肺癌肺叶切除术中环泊酚与丙泊酚的麻醉管理效果研究

doi:10.3877/cma.j.issn.1674-6902.2026.04.007

目的

比较环泊酚与丙泊酚在达芬奇机器人肺癌肺叶切除术中的麻醉效果。

方法

选取2022年5月至2025年2月我院行达芬奇机器人肺癌肺叶切除术患者113例为对象，随机分为环泊酚组57例和丙泊酚组56例。环泊酚组术中予环泊酚0.3~0.4 mg/kg负荷剂量后0.8 mg/(kg·h)静脉泵入维持，丙泊酚组予丙泊酚1.5~2.5 mg/kg负荷剂量后5.0 mg/(kg·h)静脉泵入维持。比较两组术中心率(heart rate, HR)、平均动脉压(mean arterial pressure, MAP)、收缩压(systolic blood pressure, SBP)、舒张压(diastolic blood pressure, DBP)、脑氧饱和度(regional cerebral oxygen saturation, rSO₂)、术后苏醒时间、定向力恢复时间、简易精神状态检查量表(minimental state examination, MMSE)评分及围术期不良反应。

结果

诱导后5 min，环泊酚组MAP、SBP、DBP高于丙泊酚组(P<0.05)。麻醉后15 min，两组rSO₂差异无统计学意义[(75.54±2.57)%比(75.84±2.62)%，P＝0.565]；单肺通气10、30、60 min及恢复双肺通气20 min时，环泊酚组rSO₂高于丙泊酚组[(71.67±2.42)%比(69.54±2.37)%、(70.37±2.87)%比(68.29±4.35)%、(70.27±3.68)%比(66.31±2.13)%、(74.45±3.76)%比(71.21±2.71)%，P<0.001]。环泊酚组诱导成功时间[(1.41±0.42)min比(1.59±0.58)min]、自主呼吸恢复时间[(10.96±1.57)min比(13.28±2.02)min]、术后苏醒时间[(9.34±1.58)min比(11.57±1.82)min]及定向力恢复时间[(16.35±2.53)min比(18.98±2.42)min]短于丙泊酚组(P<0.001)。术后3 h、72 h环泊酚组MMSE评分高于丙泊酚组[(19.31±1.52)分比(17.54±1.37)分、(25.90±1.04)分比(23.31±1.13)分，P<0.001]；术后24 h两组差异无统计学意义(P＝0.711)。两组恶心呕吐、术中高血压、低血压、心动过速、心动过缓、注射部位疼痛及术后谵妄(postoperative delirium, POD)发生率差异无统计学意义(P>0.05)，丙泊酚组POD 3例(5.36%)。

结论

达芬奇机器人肺癌肺叶切除术中环泊酚较丙泊酚能维持术中血流动力学稳定，提高单肺通气期间脑氧饱和度，缩短术后苏醒及定向力恢复时间，改善早期认知功能，不增加不良反应风险，具有临床意义。

关键词: 环泊酚, 丙泊酚, 肺癌外科手术, 达芬奇机器人, 单肺通气, 脑血氧饱和度, 不良反应

Objective

To compare the anesthetic effects of ciprofol and propofol in Da Vinci robotassisted lung cancer lobectomy.

Methods

A total of 113 patients who underwent Da Vinci robotassisted lung cancer lobectomy in our hospital from May 2022 to February 2025 were enrolled and randomly divided into a ciprofol group 57 cases and a propofol group 56 cases. The ciprofol group received a loading dose of 0.3~0.4 mg/kg ciprofol followed by continuous intravenous infusion at 0.8 mg/(kg·h) for maintenance, while the propofol group received a loading dose of 1.5~2.5 mg/kg propofol followed by continuous infusion at 5.0 mg/(kg·h). The two groups were compared in terms of intraoperative heart rate (HR), mean arterial pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), regional cerebral oxygen saturation (rSO₂), postoperative recovery time, orientation recovery time, MiniMental State Examination (MMSE) scores, and perioperative adverse reactions.

Results

At 5 min after induction, MAP, SBP, and DBP in the ciprofol group were higher than those in the propofol group (P<0.05). At 15 min after anesthesia, there was no significant difference in rSO₂ between the two groups [(75.54±2.57)% vs. (75.84±2.62)%, P=0.565]; at 10, 30, and 60 min of onelung ventilation and at 20 min after resumption of twolung ventilation, rSO₂ in the ciprofol group was higher than that in the propofol group [(71.67±2.42)% vs. (69.54±2.37)%, (70.37±2.87)% vs. (68.29±4.35)%, (70.27±3.68)% vs. (66.31±2.13)%, (74.45±3.76)% vs. (71.21±2.71)%, all P<0.001]. The induction success time [(1.41±0.42) min vs. (1.59±0.58) min], spontaneous breathing recovery time [(10.96±1.57) min vs. (13.28±2.02) min], postoperative recovery time [(9.34±1.58) min vs. (11.57±1.82) min], and orientation recovery time [(16.35±2.53) min vs. (18.98±2.42) min] in the ciprofol group were shorter than those in the propofol group (all P<0.001). The MMSE scores at 3 h and 72 h after surgery in the ciprofol group were higher than those in the propofol group [(19.31±1.52) vs. (17.54±1.37), (25.90±1.04) vs. (23.31±1.13), P<0.001]; at 24 h after surgery, there was no significant difference between the two groups (P=0.711). There were no statistically significant differences between the two groups in the incidence of nausea and vomiting, intraoperative hypertension, hypotension, tachycardia, bradycardia, injection site pain, or postoperative delirium (POD) (P>0.05), POD 3 cases (5.36%) in the propofol group.

Conclusion

In Da Vinci robotassisted lung cancer lobectomy, ciprofol can better maintain intraoperative hemodynamic stability, increase cerebral oxygen saturation during onelung ventilation, shorten postoperative recovery and orientation recovery time, improve early cognitive function, and does not increase the risk of adverse reactions compared with propofol, demonstrating clinical significance.

Key words: Ciprofol, Propofol, Lung cancer surgery, Da Vinci Surgical system, One-lung ventilation, Cerebral oxygen saturation, Adverse reactions

表1 两组肺癌患者临床资料结果比较

临床资料	环泊酚组(n＝57)	丙泊酚组(n＝56)	t值	P值
性别[n(%)]			0.378	0.540
男	36(63.16)	34(60.71)
女	21(36.84)	22(39.29)
BMI[kg/m²，(±s)]	28.37±1.07	28.29±1.08	0.372	0.711
病理类型[n(%)]			0.400	0.529
肺鳞癌	20(35.09)	23(40.07)
肺腺癌	37(64.91)	33(58.93)
ASA分级[n(%)]			0.164	0.685
Ⅰ级	28(49.12)	30(53.57)
Ⅱ级	22(38.60)	20(35.71)
术后指标(±s)
麻醉时间(min)	176.25±27.14	179.67±25.98	－0.644	0.521
病灶直径(cm)	2.60±0.54	2.59±0.53	0.093	0.926
手术时间(min)	115.34±15.97	116.25±16.02	－0.284	0.777
OLV时间( min)	78.41±4.07	78.37±5.08	0.372	0.711
FEV₁/FVC(%)	79.40±4.26	80.31±5.02	－0.977	0.331

表1 两组肺癌患者临床资料结果比较

临床资料	环泊酚组(n＝57)	丙泊酚组(n＝56)	t值	P值
性别[n(%)]			0.378	0.540
男	36(63.16)	34(60.71)
女	21(36.84)	22(39.29)
BMI[kg/m²，(±s)]	28.37±1.07	28.29±1.08	0.372	0.711
病理类型[n(%)]			0.400	0.529
肺鳞癌	20(35.09)	23(40.07)
肺腺癌	37(64.91)	33(58.93)
ASA分级[n(%)]			0.164	0.685
Ⅰ级	28(49.12)	30(53.57)
Ⅱ级	22(38.60)	20(35.71)
术后指标(±s)
麻醉时间(min)	176.25±27.14	179.67±25.98	－0.644	0.521
病灶直径(cm)	2.60±0.54	2.59±0.53	0.093	0.926
手术时间(min)	115.34±15.97	116.25±16.02	－0.284	0.777
OLV时间( min)	78.41±4.07	78.37±5.08	0.372	0.711
FEV₁/FVC(%)	79.40±4.26	80.31±5.02	－0.977	0.331

表2 两组肺癌患者肿瘤标志物结果比较(

±s)

肿瘤标志物	环泊酚组(n＝57)	丙泊酚组(n＝56)	t值	P值
CEA(ng/ml)	3.52±1.23	3.48±1.31	0.167	0.868
CYFRA21-1(ng/ml)	2.35±0.85	2.38±0.82	－0.190	0.850
NSE(ng/ml)	10.25±2.34	10.31±2.41	－0.134	0.894
SCC-Ag(ng/ml)	0.68±0.25	0.70±0.27	－0.408	0.684
ProGRP(pg/ml)	35.26±8.45	35.81±8.62	－0.342	0.733

表2 两组肺癌患者肿瘤标志物结果比较(

±s)

肿瘤标志物	环泊酚组(n＝57)	丙泊酚组(n＝56)	t值	P值
CEA(ng/ml)	3.52±1.23	3.48±1.31	0.167	0.868
CYFRA21-1(ng/ml)	2.35±0.85	2.38±0.82	－0.190	0.850
NSE(ng/ml)	10.25±2.34	10.31±2.41	－0.134	0.894
SCC-Ag(ng/ml)	0.68±0.25	0.70±0.27	－0.408	0.684
ProGRP(pg/ml)	35.26±8.45	35.81±8.62	－0.342	0.733

表3 两组肺癌患者胸部影像学结果[n(%)]

影像学表现	环泊酚组(n＝57)	丙泊酚组(n＝56)	t/χ²值	P值
病灶部位			0.275	0.784
右肺	32(56.14)	30(53.57)
左肺	25(43.86)	26(46.43)
合并结节	23(40.35)	22(39.29)	0.115	0.909
结节类型			0.188	0.910
实性结节	8(14.04)	7(12.50)
部分实性结节	10(17.54)	9(16.07)
纯磨玻璃结节	5(8.77)	6(10.71)

表3 两组肺癌患者胸部影像学结果[n(%)]

影像学表现	环泊酚组(n＝57)	丙泊酚组(n＝56)	t/χ²值	P值
病灶部位			0.275	0.784
右肺	32(56.14)	30(53.57)
左肺	25(43.86)	26(46.43)
合并结节	23(40.35)	22(39.29)	0.115	0.909
结节类型			0.188	0.910
实性结节	8(14.04)	7(12.50)
部分实性结节	10(17.54)	9(16.07)
纯磨玻璃结节	5(8.77)	6(10.71)

表4 两组肺癌患者血流动力学对比(

±s)

组　别	例数	HR(次/min)				MAP(mmHg)
组　别	例数	T0	T1	T2	T3	T0	T1	T2	T3
环泊酚组	57	72.15±6.69	71.85 ±9.02	80.06±8.25	80.85±5.63	82.14±7.34	79.00±5.96	88.34±7.83	81.70±7.77
丙泊酚组	56	70.86±6.52	77.25±8.25	81.25±7.35	80.35±5.87	81.84±6.98	84.25±7.81	87.53±8.61	80.50±7.33
t值		0.013	－3.124	－0.762	0.435	0.209	－3.779	0.492	0.794
P值		0.989	0.002	0.448	0.665	0.835	0.001	0.624	0.429
组别	例数	SBP(mmHg)				DBP(mmHg)
组别	例数	T0	T1	T2	T3	T0	T1	T2	T3
环泊酚组	57	130.45±9.92	130.14±8.87	134.85±8.23	131.35±7.98	84.41±6.25	93.58±8.03	93.25±8.03	83.02±7.02
丙泊酚组	56	129.64±10.25	127.65±8.92	133.57±8.71	130.54±8.24	84.01±7.02	85.36±7.12	92.83±8.12	84.12±8.06
t值		0.402	－4.784	0.755	－0.734	0.301	－5.416	0.260	－0.728
P值		0.689	0.001	0.452	0.465	0.764	0.001	0.795	0.469

表4 两组肺癌患者血流动力学对比(

±s)

组　别	例数	HR(次/min)				MAP(mmHg)
组　别	例数	T0	T1	T2	T3	T0	T1	T2	T3
环泊酚组	57	72.15±6.69	71.85 ±9.02	80.06±8.25	80.85±5.63	82.14±7.34	79.00±5.96	88.34±7.83	81.70±7.77
丙泊酚组	56	70.86±6.52	77.25±8.25	81.25±7.35	80.35±5.87	81.84±6.98	84.25±7.81	87.53±8.61	80.50±7.33
t值		0.013	－3.124	－0.762	0.435	0.209	－3.779	0.492	0.794
P值		0.989	0.002	0.448	0.665	0.835	0.001	0.624	0.429
组别	例数	SBP(mmHg)				DBP(mmHg)
组别	例数	T0	T1	T2	T3	T0	T1	T2	T3
环泊酚组	57	130.45±9.92	130.14±8.87	134.85±8.23	131.35±7.98	84.41±6.25	93.58±8.03	93.25±8.03	83.02±7.02
丙泊酚组	56	129.64±10.25	127.65±8.92	133.57±8.71	130.54±8.24	84.01±7.02	85.36±7.12	92.83±8.12	84.12±8.06
t值		0.402	－4.784	0.755	－0.734	0.301	－5.416	0.260	－0.728
P值		0.689	0.001	0.452	0.465	0.764	0.001	0.795	0.469

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Study on the anesthetic management effects of ciprofol and propofol in Da Vinci robotassisted lung cancer lobectomy

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Study on the anesthetic management effects of ciprofol and propofol in Da Vinci robotassisted lung cancer lobectomy