Chen Zhen, Liu Ying-Ying, Hu Qian, Wang Jia-Sheng, Cao Rui-Yang, Yu Su-Ting, Lu Feng, Zhong Mao-Lin, Liang Wei-Dong, Wang Lifeng
The First Clinical Medical College of Gannan Medical University, Ganzhou, Jiangxi, People's Republic of China.
Guangdong Provincial People's Hospital Ganzhou Hospital, Ganzhou, Jiangxi, People's Republic of China.
Drug Des Devel Ther. 2025 Jul 19;19:6207-6218. doi: 10.2147/DDDT.S524319. eCollection 2025.
As a novel intravenous anaesthetic, ciprofol is widely used in clinical practice. However, its potential association with postoperative delirium (POD) is unclear. Silent information regulator factor 3(SIRT3) could regulate mitochondrial function, initiate mitochondrial autophagy, and has played an important role in maintaining normal neuronal cell function. This trial aimed to explore the effect of ciprofol on the pathogenesis of POD and whether SIRT3 had a correlation with the pathogenesis of POD.
One hundred fourteen elderly patients scheduled for elective hip joint surgery were included in this randomized controlled, double blind study. The patients were randomly assigned at a 1:1 ratio to either the ciprofol group (Group C, induction of anaesthesia with 0.3 mg/kg ciprofol) or the propofol group (Group P, induction of anaesthesia with 1.5 mg/kg propofol). On postoperative days 1 and 3, the 3D-CAM scale was used to assess whether POD occurred in both groups of patients.
No statistically significant difference was observed in the general condition of the patients in the two groups. Within the first 3 days after surgery, the incidence of POD was lower in Group C than in Group P (5.5% vs 20%; = 0.022). At 1 min of administration, ciprofol had less circulatory effects and a lower incidence of injection pain, but a higher incidence of muscle twitching than propofol. On postoperative day 1, SIRT3 expression was greater in Group C than in Group P ( = 0.028). Additionally, SIRT3 expression was found to be correlated with POD. The serum SIRT3 level on postoperative day 1 had an area under the receiver operating characteristic (ROC) curve of 0.8540 ( < 0.001), with a detection threshold of 1.565 ng/mL, yielding a sensitivity of 0.820 and a specificity of 0.900.
In this study, we found that ciprofol was associated with a lower incidence of POD and had a minimal impact on circulatory function. SIRT3 expression and POD were correlated. A serum SIRT3 level less than 1.565 ng/mL on postoperative day 1 may indicate a likelihood of POD, highlighting its potential diagnostic value.
环丙泊酚作为一种新型静脉麻醉药，在临床实践中被广泛应用。然而，其与术后谵妄（POD）的潜在关联尚不清楚。沉默信息调节因子3（SIRT3）可调节线粒体功能，启动线粒体自噬，并在维持正常神经元细胞功能中发挥重要作用。本试验旨在探讨环丙泊酚对POD发病机制的影响以及SIRT3与POD发病机制是否相关。
114例计划行择期髋关节手术的老年患者纳入本随机对照双盲研究。患者按1:1比例随机分为环丙泊酚组（C组，用0.3mg/kg环丙泊酚诱导麻醉）或丙泊酚组（P组，用1.5mg/kg丙泊酚诱导麻醉）。术后第1天和第3天，使用3D-CAM量表评估两组患者是否发生POD。
两组患者的一般情况无统计学显著差异。术后前3天内，C组POD发生率低于P组（5.5%对20%；P = 0.022）。给药1分钟时，环丙泊酚对循环的影响较小，注射痛发生率较低，但肌肉抽搐发生率高于丙泊酚。术后第1天，C组SIRT3表达高于P组（P = 0.028）。此外，发现SIRT3表达与POD相关。术后第1天血清SIRT3水平的受试者工作特征（ROC）曲线下面积为0.8540（P < 0.001），检测阈值为1.565ng/mL，灵敏度为0.820，特异度为0.900。
在本研究中，我们发现环丙泊酚与较低的POD发生率相关，且对循环功能影响极小。SIRT3表达与POD相关。术后第1天血清SIRT3水平低于1.565ng/mL可能提示发生POD的可能性，突出了其潜在的诊断价值。
