目的 观察基于不同体质量标量计算的环泊酚剂量联合芬太尼在超重与肥胖患者的无痛胃镜检查中的有效性及安全性。 方法 选取2024年3—9月于中山大学附属第七医院行无痛胃镜检查的294例超重与肥胖患者，体质量指数（BMI）25 ~ 40 kg/m2，用随机数字表法将患者分为全体质量组（TBW）、校正体质量组（ABW）和理想体质量组（IBW），各98例。所有入选者均采用相应体质量标量计算的环泊酚0.4 mg/kg复合芬太尼50 μg进行麻醉诱导，继以环泊酚1 mg/（kg·h）维持输注。比较各组的麻醉效果、麻醉恢复时间，比较T₀（麻醉前）、T₁（内镜检查开始）、T₂（镜体过梨状隐窝）、T₃（检查幽门）、T₄（检查结束）、T₅（入复苏室清醒）、T₆（离开复苏室）的血流动力学指标及不良反应。 结果 与TBW组相比，IBW组患者的环泊酚追加率更高，苏醒时间更短，差异均有统计学意义（P 0.05）。与TBW组相比，ABW组患者的苏醒时间更短，差异有统计学意义（P 0.05）；环泊酚追加率差异无统计学意义（P 0.05）。与ABW组相比，IBW组患者的环泊酚追加率及苏醒时间差异均无统计学意义（P 0.05）。3组患者围术期呼吸抑制、低氧血症、镇静成功率、低血压、心动过缓、体动、呛咳、呃逆、头晕、恶心、呕吐发生率差异无统计学意义（P 0.05）。3组患者围术期血流动力学对比差异无统计学意义（P 0.05）。 结论 超重与肥胖患者接受无痛胃镜检查时，采用基于ABW计算的环泊酚联合50 μg芬太尼麻醉方案是一种安全且有效的选择。

Objective To evaluate the efficacy and safety of ciprofol dosing calculated using different body weight scalars—total body weight （TBW）， adjusted body weight （ABW）， and ideal body weight （IBW）—combined with fentanyl for procedural sedation during gastroscopy in overweight and obese patients. Methods A total of 294 overweight and obese patients （BMI 25 - 40 kg/m2） undergoing sedated gastroscopy at The Seventh Affiliated Hospital， Sun Yat-sen University， between March and September 2024 were enrolled. Participants were randomly assigned in a 1∶1∶1 ratio to one of three groups （n = 98 per group） using a random number table： TBW group， ABW group， or IBW group. Anesthesia was induced with fentanyl 50 μg plus ciprofol 0.4 mg/kg （calculated according to the assigned body weight scalar）， followed by maintenance infusion of ciprofol at 1 mg/（kg·h） based on the same scalar. Primary outcomes included ciprofol rescue dose requirements and recovery time. Secondary outcomes encompassed sedation success rate， hemodynamic parameters （MAP， HR， SpO?） at predefined timepoints （T?： pre-induction； T?： scope insertion； T?： passage through piriform fossa； T?： pyloric examination； T?： procedure completion； T?： awakening in recovery room； T?： discharge from recovery）， and incidence of adverse events. Results Compared with the TBW group， the IBW group required a significantly higher cumulative rescue dose of ciprofol （P 0.05） and achieved shorter recovery time （P 0.05）. The ABW group also demonstrated shorter recovery time versus TBW （P 0.05）， with no significant difference in rescue dose requirements （P 0.05）. No significant differences were observed between the ABW and IBW groups regarding rescue dose or recovery time （both P 0.05）. The incidence of adverse events—including respiratory depression， hypoxemia， hypotension， bradycardia， involuntary movement， cough， singultus， dizziness， nausea， and vomiting—and the sedation success rate did not differ significantly among the three groups （all P 0.05）. Perioperative hemodynamic profiles remained stable and comparable across groups （all P 0.05）. Conclusion For overweight and obese patients undergoing sedated gastroscopy， a ciprofol-fentanyl anesthesia regimen with ciprofol dosing calculated by adjusted body weight （ABW） provides optimal balance between anesthetic efficacy and recovery efficiency， while maintaining a favorable safety profile comparable to TBW- or IBW-based dosing. ABW-based dosing is therefore recommended as the preferred weight scalar in this population.