通讯作者: 李元海▲, liyuanhai-1@163.com

DOI：10.12201/bmr.202610.00029

omparison of the Effects of Fospropofol Disodium and Etomidate for Induction of General Anesthesia in Older Patients with Frailty

• 摘要：目的 比较磷丙泊酚二钠联合舒芬太尼与依托咪酯用于老年衰弱患者全身麻醉诱导的有效性和安全性。方法 选择2026年1月至6月于安徽医科大学第四附属医院择期行气管插管全身麻醉的老年衰弱患者88例。采用随机数字表法分为磷丙泊酚二钠组（F组）和依托咪酯组（E组）。两组均先给予舒芬太尼0.4 μg/kg及咪达唑仑0.03 mg/kg，F组静脉给予磷丙泊酚二钠7.5 mg/kg，E组给予依托咪酯0.3 mg/kg。结果 两组诱导成功率均为100%。F组睫毛反射消失时间及MOAA/S评分首次≤1分时间均长于E组（均P＜0.001）。F组与E组低血压发生率分别为43.2%和40.9%，差异无统计学意义（P=0.828），率差为2.3%，95% CI为-17.7%～22.0%；95% CI上限超过预设非劣效界值12%，未能证实F组在主要终点上非劣效于E组。F组术中丙泊酚单位时间用量低于E组（P＜0.001），两组苏醒时间差异无统计学意义。T2～T4时F组MAP低于E组，T2和T3时F组HR低于E组。F组肌阵挛发生率低于E组（0 vs 15.9%，P=0.012），感觉异常发生率高于E组（18.2% vs 0，P=0.006）。结论 磷丙泊酚二钠在老年衰弱患者全身麻醉诱导中可取得满意的镇静效果，但起效慢于依托咪酯。本研究未能证实其在诱导期低血压发生率方面非劣效于依托咪酯，但其在气管插管即刻表现为MAP和HR升幅较小，提示其可能具有一定的气管插管应激反应抑制作用。此外，磷丙泊酚二钠可减少肌阵挛及后续丙泊酚用量，但感觉异常较常见，临床应用时应结合患者循环储备及不良反应风险个体化选择。

  关键词： 磷丙泊酚二钠；依托咪酯；衰弱；老年患者；全身麻醉诱导; ; ; ; 

   

  Abstract: Objective To compare the efficacy and safety of fospropofol disodium combined with sufentanil versus etomidate for induction of general anesthesia in older patients with frailty. Methods Eighty-eight older patients with frailty who were scheduled for elective surgery under tracheal intubation general anesthesia at the Fourth Affiliated Hospital of Anhui Medical University from January to June 2026 were enrolled. Using a random number table, patients were assigned to a fospropofol disodium group (group F) or an etomidate group (group E). Both groups received sufentanil 0.4 μg/kg and midazolam 0.03 mg/kg before the study drug. Group F received intravenous fospropofol disodium 7.5 mg/kg, whereas group E received etomidate 0.3 mg/kg. Results The induction success rate was 100% in both groups. The time to loss of eyelash reflex and the time to the first Modified Observer''s Assessment of Alertness/Sedation score ≤1 were longer in group F than in group E (both P<0.001). The incidence of hypotension was 43.2% in group F and 40.9% in group E (P=0.828), with a risk difference of 2.3% (95% CI, -17.7% to 22.0%). Because the upper limit of the 95% CI exceeded the prespecified non-inferiority margin of 12%, non-inferiority of fospropofol disodium to etomidate for the primary endpoint was not demonstrated. Propofol consumption per unit time was lower in group F (P<0.001), whereas recovery time did not differ between groups. MAP was lower in group F at T2-T4, and heart rate was lower in group F at T2 and T3. Myoclonus occurred less frequently in group F than in group E (0 vs 15.9%, P=0.012), whereas paresthesia occurred more frequently in group F (18.2% vs 0, P=0.006). Conclusion Fospropofol disodium provides satisfactory sedation for induction of general anesthesia in older patients with frailty but has a slower onset than etomidate. Non-inferiority for induction-related hypotension was not established. Fospropofol disodium may attenuate the immediate hemodynamic response to tracheal intubation and reduce myoclonus and subsequent propofol requirements, but paresthesia is more common. Individualized selection should consider circulatory reserve and the risk of adverse reactions.

  Key words: Fospropofol disodium; Etomidate; Frailty; Aged; General anesthesia induction

  提交时间：2026-10-13

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• 序号	提交日期	编号	操作
  1	2026-08-24	10.12201/bmr.202610.00029V1	下载

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