探讨环泊酚联合瑞芬太尼抑制胃镜置入反应的量效关系。

纳入2024年1—4月中国人民解放军联勤保障部队第九〇四医院收治拟行无痛胃镜检查的患者。纳入标准：年龄18~65岁、美国麻醉医师协会分级Ⅰ~Ⅱ级、体重指数18.5~27.9 kg/m²。静脉注射环泊酚，注射时间30 s，静脉泵注瑞芬太尼1.0 μg/kg，泵注时间60 s。使用Dixon序贯法调整患者环泊酚剂量，初始剂量设定为0.30 mg/kg，调整范围为±0.02 mg/kg。使用Probit回归计算环泊酚联合1.0 μg/kg瑞芬太尼抑制胃镜置入反应的半数有效量（ED50）、95%有效量（ED95）。记录患者入内镜室即刻（T0）、环泊酚注射后1 min（T1）、胃镜置入即刻（T2）、胃镜撤出即刻（T3）、完全苏醒时（T4）的心率、无创平均动脉压（MAP）和血氧饱和度。记录苏醒时间、麻醉后复苏室停留时间及围手术期并发症。

依照Dixon序贯法，在纳入28例患者后终止研究。Probit回归结果显示，环泊酚联合1.0 μg/kg瑞芬太尼抑制胃镜置入反应的ED50为0.254 mg/kg （95% CI 0.242~0.266）；ED95为0.290 mg/kg（95% CI 0.260~0.320）。患者T1、T2、T3时点的MAP明显低于T0时点，差异有统计学意义（P<0.05）。患者苏醒时间为（5.3±1.8）min、麻醉后复苏室停留时间为（46.4±11.1）min。患者在术中出现心动过缓2例、低氧血症2例和低血压3例。

环泊酚联合1.0 μg/kg瑞芬太尼抑制胃镜置入反应的ED50、ED95分别为0.254、0.290 mg/kg，该麻醉方案围手术期并发症发生率较低，具有较高的有效性和安全性。

To evaluate the dose-effect relationship of ciprofol combined with remifentanil to inhibit responses to gastroscope insertion.

Patients who planned to undergo gastroscopy from January 2024 to April 2024 were included. Inclusion criteria: age 18-65 years old, American Society of Anesthesiologists (ASA) grade Ⅰ to Ⅱ, body mass index (BMI) 18.5-27.9 kg/m². Ciprofol was injected intravenously for 30 s, remifentanil was injected intravenously for 1.0 μg/kg for 60 s. The patients' ciprofol dose was adjusted by Dixon sequential method. The initial dose was set at 0.30 mg/kg and the adjustment range was ±0.02 mg/kg. Probit regression was used to calculate the ED50 and ED95 of ciprofol combined with 1.0 μg/kg remifentanil to inhibit gastroscope insertion. The heart rate, noninvasive mean arterial pressure (MAP) and oxyhemoglobin saturation (SpO₂) of patients were recorded immediately after entering the endoscopy room (T0), 1 min after ciprofol injection (T1), immediately after gastroscope insertion (T2), immediately after gastroscope withdrawal (T3), and at the time of recovery (T4). Recovery time, length of postanesthesia care unit (PACU) stay and perioperative complications were recorded.

According to the Dixon sequential method, the study was terminated after 28 patients were enrolled. Probit regression results showed that the ED50 of cipofol combined with 1.0 μg/kg remifentanil inhibited responses to gastroscope insertion was 0.254 mg/kg (95% CI: 0.242-0.266 mg/kg). The ED95 was 0.290 mg/kg (95% CI: 0.260-0.320 mg/kg). The MAP of T1, T2 and T3 was significantly lower than that of T0, with statistically significant differences (P<0.05). The recovery time of patients was (5.3±1.8) min and the length of PACU stay was (46.4±11.1) min. Bradycardia, hypoxemia and hypotension occurred in 2, 2 and 3 patients, respectively.

The ED50 and ED95 of cipofol combined with 1.0 μg/kg remifentanil to inhibit responses to gastroscope insertion are 0.254 mg/kg and 0.290 mg/kg, respectively. This anesthesia program has a low incidence of perioperative complications and has high efficacy and safety.