Remimazolam tosylate vs. ciprofol for thoracoscopic esophagectomy for esophageal cancer: A propensity score-matched study

doi:10.3877/cma.j.issn.2095-2015.2026.04.014

Abstract

Abstract:

Objective

To investigate the anesthetic effects of remimazolam tosilate versus ciprofol in patients undergoing thoracoscopic esophagectomy and their impact on postoperative nausea and vomiting (PONV).

Methods

A prospective cohort study was conducted, enrolling 124 patients scheduled for thoracoscopic esophagectomy at Hubei Medical College Affiliated Chinese Medicine Dongfeng General Hospital from June 2021 to June 2024. Patients were divided into a control group (anesthetized with ciprofol, n=60) and an observation group (anesthetized with remimazolam tosilate, n=64) based on the intraoperative anesthetic regimen. To balance baseline covariates between groups, 1∶1 propensity score matching was performed, resulting in 50 patients in each group. The two groups were compared regarding surgical outcomes, hemodynamic changes, stress response indicators, and PONV occurrence.

Results

The observation group showed significantly shorter post-anesthesia care unit (PACU) stay time and anesthesia recovery time, as well as lower intraoperative sufentanil consumption, intraoperative remifentanil consumption, and postoperative patient-controlled intravenous analgesia usage compared with the control group (P<0.05). At skin incision, tumor resection, and after suture, heart rate, mean arterial pressure, and oxygen saturation were significantly higher in the observation group than in the control group (P<0.05). At 6 hours postoperatively, the levels of epinephrine, dopamine, and norepinephrine were significantly lower in the observation group than in the control group (P<0.05). Within 48 hours after surgery, the incidence of PONV, visual analog scale scores, and verbal descriptive scale scores were significantly lower in the observation group than in the control group (P<0.05).

Conclusion

Compared with ciprofol, remimazolam tosilate for anesthesia in thoracoscopic esophagectomy can better shorten PACU stay and anesthesia recovery time, reduce intraoperative opioid consumption, maintain hemodynamic stability, attenuate stress responses, and decrease the risk of PONV.

Key words: Remimazolam tosilate, Ciprofol, Thoracoscopic esophagectomy, Propensity score matching, Postoperative nausea and vomiting

Qinghai Wu, Xiaomin Yu, Shan Wang, Yuzhen Li, Junli Kong. Remimazolam tosylate vs. ciprofol for thoracoscopic esophagectomy for esophageal cancer: A propensity score-matched study[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2026, 16(04): 367-373.

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References 22

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组别		倾向性评分匹配前				倾向性评分匹配后				SMD
组别		观察组(n=64)	对照组(n=60)	χ²/t值	P值	观察组(n=50)	对照组(n=50)	χ²/t值	P值	SMD
性别[例(%)]	男	34(53.12)	20(33.33)	4.934	0.026	21(42.00)	20(40.00)	0.041	0.839	0.041
性别[例(%)]	女	30(46.88)	40(66.67)	4.934	0.026	29(58.00)	30(60.00)	0.041	0.839	0.041
年龄(岁,±s)		57.64±4.11	54.36±4.20	4.394	<0.001	55.12±4.17	55.66±4.23	0.649	0.518	0.083
体重指数(kg/m²,±s)		19.54±1.22	20.29±1.43	3.148	0.002	19.63±1.32	19.51±1.28	0.887	0.254	0.092
美国麻醉医师协会分级[例(%)]	Ⅰ级	20(31.25)	30(50.00)	4.524	0.033	20(40.00)	25(50.00)	1.010	0.315	0.085
美国麻醉医师协会分级[例(%)]	Ⅱ级	44(68.75)	30(50.00)	4.524	0.033	30(60.00)	25(50.00)	1.010	0.315	0.085
TNM分期[例(%)]	Ⅰ期	14(21.88)	26(43.33)	6.907	0.032	14(28.00)	18(36.00)	0.541	0.763	0.069
	Ⅱ期	32(50.00)	24(40.00)			26(52.00)	24(48.00)
	Ⅲ期	18(28.12)	10(16.67)			10(20.00)	10(20.00)
既往术后恶心呕吐史[例(%)]		8(12.5)	14(23.33)	2.490	0.115	7(14.00)	8(16.00)	0.078	0.779	0.056
晕动病史[例(%)]		10(15.63)	15(25.00)	1.691	0.193	9(18.00)	10(20.00)	0.065	0.779	0.051
吸烟史[例(%)]		29(45.31)	18.00(30.00)	3.085	0.079	20(40.00)	19(38.00)	0.42	0.838	0.041

组别		倾向性评分匹配前				倾向性评分匹配后				SMD
组别		观察组(n=64)	对照组(n=60)	χ²/t值	P值	观察组(n=50)	对照组(n=50)	χ²/t值	P值	SMD
性别[例(%)]	男	34(53.12)	20(33.33)	4.934	0.026	21(42.00)	20(40.00)	0.041	0.839	0.041
性别[例(%)]	女	30(46.88)	40(66.67)	4.934	0.026	29(58.00)	30(60.00)	0.041	0.839	0.041
年龄(岁,±s)		57.64±4.11	54.36±4.20	4.394	<0.001	55.12±4.17	55.66±4.23	0.649	0.518	0.083
体重指数(kg/m²,±s)		19.54±1.22	20.29±1.43	3.148	0.002	19.63±1.32	19.51±1.28	0.887	0.254	0.092
美国麻醉医师协会分级[例(%)]	Ⅰ级	20(31.25)	30(50.00)	4.524	0.033	20(40.00)	25(50.00)	1.010	0.315	0.085
美国麻醉医师协会分级[例(%)]	Ⅱ级	44(68.75)	30(50.00)	4.524	0.033	30(60.00)	25(50.00)	1.010	0.315	0.085
TNM分期[例(%)]	Ⅰ期	14(21.88)	26(43.33)	6.907	0.032	14(28.00)	18(36.00)	0.541	0.763	0.069
	Ⅱ期	32(50.00)	24(40.00)			26(52.00)	24(48.00)
	Ⅲ期	18(28.12)	10(16.67)			10(20.00)	10(20.00)
既往术后恶心呕吐史[例(%)]		8(12.5)	14(23.33)	2.490	0.115	7(14.00)	8(16.00)	0.078	0.779	0.056
晕动病史[例(%)]		10(15.63)	15(25.00)	1.691	0.193	9(18.00)	10(20.00)	0.065	0.779	0.051
吸烟史[例(%)]		29(45.31)	18.00(30.00)	3.085	0.079	20(40.00)	19(38.00)	0.42	0.838	0.041

组别	例数	手术时间(min)	术中出血量(mL)	睫毛反射消失时间(s)	PACU停留时间(min)	麻醉苏醒时间(min)	术中舒芬太尼使用量(μg)	术中瑞芬太尼使用量(μg)	PCIA使用量(mL)	去氧肾上腺素用量(μg)	阿托品使用率[例(%)]
观察组	50	161.30±21.21	64.32±11.23	31.22±6.44	16.33±3.66	2.66±1.02	21.25±2.22	32.11±2.68	32.22±4.65	85.60±15.22	6(12.00)
对照组	50	165.22±22.05	66.76±11.21	32.69±6.47	18.22±3.74	3.14±1.23	23.56±2.54	35.14±2.88	35.68±4.66	88.36±16.58	12(24.00)
χ²/t值		0.915	1.098	1.150	2.579	2.149	2.889	3.668	2.998	0.238	2.149
P值		0.362	0.275	0.253	0.011	0.034	0.014	0.002	0.008	0.814	0.118

组别	例数	手术时间(min)	术中出血量(mL)	睫毛反射消失时间(s)	PACU停留时间(min)	麻醉苏醒时间(min)	术中舒芬太尼使用量(μg)	术中瑞芬太尼使用量(μg)	PCIA使用量(mL)	去氧肾上腺素用量(μg)	阿托品使用率[例(%)]
观察组	50	161.30±21.21	64.32±11.23	31.22±6.44	16.33±3.66	2.66±1.02	21.25±2.22	32.11±2.68	32.22±4.65	85.60±15.22	6(12.00)
对照组	50	165.22±22.05	66.76±11.21	32.69±6.47	18.22±3.74	3.14±1.23	23.56±2.54	35.14±2.88	35.68±4.66	88.36±16.58	12(24.00)
χ²/t值		0.915	1.098	1.150	2.579	2.149	2.889	3.668	2.998	0.238	2.149
P值		0.362	0.275	0.253	0.011	0.034	0.014	0.002	0.008	0.814	0.118

组别	例数	心率(次/min,±s)
组别	例数	T₀	T₁	T₂	T₃
观察组	50	79.91±2.50	75.15±2.74^ab	74.64±2.66^ab	77.97±2.42^ab
对照组	50	79.83±2.43	73.58±2.63^a	71.83±2.61^a	75.95±2.55^a
t值		0.162	2.923	5.332	4.063
P值		0.871	0.004	<0.001	<0.001
F_组间/P_组间值		123.524/<0.001
F_时间/P_时间值		88.569/<0.001
_/F_{组间时间}/P_{组间时间}值		23.558/<0.001
组别	例数	平均动脉压(mmHg,±s)
组别	例数	T₀	T₁	T₂	T₃
观察组	50	86.89±5.88	83.73±5.57^ab	82.21±4.35^ab	84.97±5.48^ab
对照组	50	86.47±6.07	80.26±5.23^a	78.77±4.64^a	81.31±5.62^a
t值		0.351	3.211	3.825	3.300
P值		0.726	0.002	<0.001	<0.001
F_组间/P_组间		120.120/<0.001
F_时间/P_时间		94.331/<0.001
F_{组间时间}/P_{组间时间}		21.336/<0.001
组别	血氧饱和度[%,M(Q1,Q3)]
组别	T₀	T₁	T₂	T₃
观察组	99.00(99.00,100.00)	96.00(95.00,97.00)^ab	96.00(95.00,97.00)^ab	98.00(97.00,99.00)^ab
对照组	99.00(99.00,100.00)	93.00(91.00,94.00)^a	95.00(94.00,96.00)^a	97.00(96.00,98.00)^a
Z值	0.805	5.933	4.668	4.823
P值	0.238	<0.001	<0.001	<0.001

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