环泊酚在老年患者麻醉中的应用研究进展

Research Progress on the Application of Ciprofol in Anesthesia for Elderly Patients

摘要: 环泊酚是我国自主研发的新型静脉麻醉药，具有起效快、苏醒快、循环稳定、呼吸抑制少、注射痛轻微等药理学特点。人口老龄化背景下，老年手术患者占比逐年升高，老年群体并非均质群体，包含普通健康老年、高龄、衰弱、合并多脏器功能不全等异质性极大的亚组，不同亚组器官退行性改变程度、药物耐受水平差异显著，多病共存、多重用药现象十分普遍，机体对麻醉药物的耐受性显著下降，使得围术期麻醉管理面临诸多独特挑战。老年患者围术期容易发生血流动力学剧烈波动、呼吸抑制、低氧血症、术后谵妄、术后认知功能障碍等一系列不良事件，严重影响手术安全与术后康复质量。丙泊酚作为目前临床主流静脉麻醉药物，虽然麻醉效能确切，但注射痛、循环与呼吸抑制等不良反应在老年人群中表现尤为突出。环泊酚作为国产I类创新静脉麻醉药，分子结构在丙泊酚基础上进行修饰优化，药理特性得到进一步提升。本文系统综述环泊酚在老年患者麻醉中的应用研究进展，重点阐述其药理学特性、不同老年亚组的用药策略框架、在全身麻醉诱导与维持、内镜诊疗镇静及特殊术式中的应用证据；每一场景下同步整合安全性证据，并结合药理机制解析疗效差异，同时批判性评价现有临床研究质量，分析研究异质性来源。现有研究表明，环泊酚在老年患者中可获得与丙泊酚相当的麻醉效能，但在血流动力学稳定性、呼吸安全性及注射痛发生率方面具有显著优势。但当前高质量大样本临床证据仍然有限，尤其缺乏针对衰弱老年、多重用药、重要脏器功能不全老年人群的专门RCT与长期随访数据。未来需进一步开展大样本、多中心随机对照试验，验证其在降低术后谵妄、改善远期预后等方面的潜在价值，完善基于老年生理状态分层的个体化给药方案，指导临床更加安全合理用药。

Abstract: Ciprofol is a novel intravenous anesthetic independently developed in China, characterized by rapid onset, quick recovery, stable hemodynamics, minimal respiratory depression, and mild injection pain. Under the background of population aging, the proportion of elderly surgical patients is increasing year by year. The elderly population is highly heterogeneous, including robust elderly, advanced-age, frail elderly, and patients with multi-organ dysfunction, with great differences in degenerative organ changes and drug tolerance among subgroups. Multimorbidity and polypharmacy are common phenomena. The tolerance of the body to anesthetics decreases significantly, bringing many unique challenges to perioperative anesthesia management. Elderly patients are prone to a series of adverse events such as severe hemodynamic fluctuation, respiratory depression, hypoxemia, postoperative delirium and postoperative cognitive dysfunction, which seriously affect surgical safety and postoperative rehabilitation quality. As the mainstream intravenous anesthetic in clinical practice, propofol has definite anesthetic efficacy, but adverse reactions such as injection pain, circulatory and respiratory inhibition are particularly prominent in the elderly population. As a domestic class 1 innovative intravenous anesthetic, ciprofol has its molecular structure modified and optimized on the basis of propofol, and its pharmacological properties are further improved. This article systematically reviews the research progress of ciprofol application in elderly patients undergoing anesthesia, focusing on its pharmacological characteristics, medication strategy framework for different elderly subgroups, evidence in general anesthesia induction and maintenance, sedation for endoscopic procedures and special surgical procedures. Safety evidence is integrated into each clinical scenario, efficacy differences are analyzed combined with pharmacological mechanisms, and the quality of existing clinical studies is critically evaluated to explore sources of research heterogeneity. Current studies demonstrate that ciprofol achieves comparable anesthetic efficacy to propofol in elderly patients, with significant advantages in hemodynamic stability, respiratory safety, and incidence of injection pain. However, high-quality and large-sample clinical evidence is still limited, especially specialized RCTs and long-term follow-up data targeting frail elderly, polypharmacy patients and elderly with significant organ dysfunction. Future large-scale, multicenter randomized controlled trials are needed to validate its potential value in reducing postoperative delirium and improving long-term outcomes, optimize individualized medication regimens stratified by physiological status of the elderly, and guide safer and more rational clinical medication.