目的 探讨环泊酚联合阿芬太尼在胃肿物内镜黏膜下剥离术（ESD）中的应用价值。方法 选取2023年1月—2024年1月行胃肿物ESD治疗患者60例,采用随机数字表法将其分为环泊酚麻醉组（试验组）和丙泊酚麻醉组（对照组）,每组各30例。其中,对照组采用丙泊酚2 mg/kg、阿芬太尼20 μg/kg、顺阿曲库铵0.15 mg麻醉诱导,丙泊酚5 mg/（kg·h）、阿芬太尼0.5 μg/（kg·min）麻醉维持。试验组采用环泊酚0.4 mg/kg、阿芬太尼20 μg/kg、顺阿曲库铵0.15 mg/kg麻醉诱导,环泊酚1 mg/（kg·h）、阿芬太尼0.5 μg/（kg·min）麻醉维持。比较两组血流动力学指标包括无创血压（NIBP）、心率（HR）、脉搏血氧饱和度（SpO₂）、呼气末二氧化碳分压（PetCO₂）、拔管时间、睁眼时间、躁动评分;监测血清去甲肾上腺素（NE）与皮质醇（cortisol,Cor）水平。结果 入室时（T0）两组NIBP、HR、SpO₂、PetCO₂无明显差异（P>0.05）;诱导后（T1）、气管插管后即刻（T2）,气管拔管后（T3）时刻NIBP、HR、SpO₂明显下降,PetCO₂上升,且相较于对照组,试验组NIBP、HR、SpO₂显著较高,PetCO₂显著较低（P<0.05）。出室时（T4）NIBP、HR、SpO₂上升,PetCO₂降低,试验组优于对照组（P<0.05）;试验组的拔管时间、睁眼时间、躁动评分均显著低于对照组（P<0.05）;入室时（T0）两组NE、Cor水平无明显差异（P>0.05）,诱导后（T1）、出室时（T4）两组NE、Cor水平均显著上升,且试验组NE、Cor水平显著低于对照组（P<0.05）。结论 相对于丙泊酚联合阿芬太尼,胃肿物ESD术中环泊酚联合阿芬太尼可以有效抑制血流动力学波动,下调NE、Cor的表达,缩短患者拔管时间、睁眼时间,减轻患者躁动。

Objective To investigate of the application value of ciprofol combined with alfentanil in endoscopic submucosal dissection （ESD） of gastric masses. Methods Sixty patients who underwent gastric mass ESD from January 2023 to January 2024 were selected and randomly divided into a ciprofol anesthesia group （experimental group） and a propofol anesthesia group （control group） using a random number table method, with 30 patients in each group. In the control group, anesthesia was induced using 2 mg/kg propofol, 20 μg/kg alfentanil, and 0.15 mg cisatracurium, and maintained with 5 mg/（kg·h） propofol and 0.5 μg/（kg·min） alfentanil. In the experimental group, anesthesia was induced using 0.4 mg/kg ciprofol, 20 μg/kg alfentanil, and 0.15 mg/kg cisatracurium, and maintained with 1 mg/（kg·h） ciprofol and 0.5 μg/（kg·min） alfentanil. Comparisons were made between the two groups for hemodynamic indicators including non-invasive blood pressure （NIBP）, heart rate （HR）, oxygen saturation （SpO₂）, and partial pressure of end tidal carbon dioxide （PetCO₂）, surgical indicators （including extubation time, eye opening time, and agitation score）, and serum norepinephrine （NE） and cortisol （Cor） levels. Results At the time of entering the operation room （T0）, there was no significant difference in NIBP, HR, SpO₂, and PetCO₂ between the two groups （P>0.05）. After induction （T1）, at tracheal intubation （T2）, and after tracheal extubation （T3）, NIBP, HR, and SpO₂ decreased significantly while PetCO₂ increased, and compared with the control group, the experimental group had significantly higher NIBP, HR, and SpO₂ and significantly lower PetCO₂ （P<0.05）. When leaving the operation room （T4）, NIBP, HR, and SpO₂ increased, while PetCO₂ decreased, and the experimental group was better than the control group （P<0.05）. The extubation time, eye opening time, and agitation score of the experimental group were all lower than those of the control group （P<0.05）. There was no significant difference in the levels of NE and Cor at T0 between the two groups （P>0.05）, while the levels of NE and Cor at T1 and T4 increased significantly in both groups, and the levels of NE and Cor in the experimental group were lower than those in the control group （P<0.05）. Conclusion Compared with propofol combined with alfentanil, the combination of ciprofol and alfentanil in ESD surgery for gastric masses can effectively reduce hemodynamics, downregulate NE and Cor expression, shorten the time for extubation and eye opening, and alleviate patient agitation.