Wang Yi-Chao, Wu Meng-Jun, Zhou Sheng-Liang, Li Zhi-Hui
Department of Thyroid & Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Laboratory of Thyroid and Parathyroid Disease, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Clin Cases. 2023 Jan 26;11(3):487-492. doi: 10.12998/wjcc.v11.i3.487.
Despite improvement in cardiopulmonary resuscitation (CPR) performance, cardiac arrest (CA) is still associated with poor prognosis. The high mortality rate is due to multi-organ dysfunction caused by cerebral ischemia and reperfusion injury (I/R). The guidelines for CPR suggest the use of therapeutic hypothermia (TH) as an effective treatment to decrease mortality and the only approach confirmed to reduce I/R injury. During TH, sedative agents (propofol) and analgesia agents (fentanyl) are commonly used to prevent shiver and pain. However, propofol has been associated with a number of serious adverse effects such as metabolic acidosis, cardiac asystole, myocardial failure, and death. In addition, mild TH alters the pharmacokinetics of agents (propofol and fentanyl) and reduces their systemic clearance. For CA patients undergoing TH, propofol can be overdosed, leading to delayed awakening, prolonged mechanical ventilation, and other subsequent complications. Ciprofol (HSK3486) is a novel anesthetic agent that is convenient and easy to administer intravenously outside the operating room. Ciprofol is rapidly metabolized and accumulates at low concentrations after continuous infusion in a stable circulatory system compared to propofol. Therefore, we hypothesized that treatment with HSK3486 and mild TH after CA could protect the brain and other organs.
尽管心肺复苏（CPR）操作有所改进，但心脏骤停（CA）的预后仍然很差。高死亡率是由于脑缺血和再灌注损伤（I/R）导致的多器官功能障碍。CPR指南建议使用治疗性低温（TH）作为降低死亡率的有效治疗方法，也是唯一被证实可减少I/R损伤的方法。在TH期间，常用镇静剂（丙泊酚）和镇痛剂（芬太尼）来预防寒战和疼痛。然而，丙泊酚与许多严重不良反应有关，如代谢性酸中毒、心搏停止、心肌衰竭和死亡。此外，轻度低温会改变药物（丙泊酚和芬太尼）的药代动力学并降低其全身清除率。对于接受TH的CA患者，丙泊酚可能会过量，导致苏醒延迟、机械通气时间延长以及其他后续并发症。环泊酚（HSK3486）是一种新型麻醉剂，在手术室以外的地方静脉注射方便易行。与丙泊酚相比，环泊酚在稳定的循环系统中连续输注后能快速代谢且在低浓度下蓄积。因此，我们推测CA后使用HSK3486和轻度TH进行治疗可保护大脑和其他器官。
