丙泊酚静脉麻醉对行取卵术患者自然杀伤细胞数量及妊娠结局的影响  

Effects of intravenous anesthesia with propofol on the number of natural killer cells and pregnancy outcome in patients undergoing oocyte retrieval

作　　者：杨晓茹 吕凯丽 赵文香[1] 崔海丽[2] 岳桂芳[1] 王花慧 张全意[1] Yang Xiaoru;Lyu Kaili;Zhao Wenxiang;Cui Haili;Yue Guifang;Wang Huahui;Zhang Quanyi(Department of Anesthesiology,the Affiliated Hospital of Binzhou Medical College,Binzhou 256603,China;Department of Laboratory Medicine,the Affiliated Hospital of Binzhou Medical College,Binzhou 256603,China)

机构地区：[1]滨州医学院附属医院麻醉科,256603 [2]滨州医学院附属医院检验科,256603

出　　处：《国际麻醉学与复苏杂志》2021年第2期145-150,共6页International Journal of Anesthesiology and Resuscitation

基　　金：滨州医学院科技计划项目(BY2016KJ31)。

摘　　要：目的评价丙泊酚静脉麻醉对行取卵术患者自然杀伤(natural killer,NK)细胞的数量及妊娠结局的影响。方法选择择期接受体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)的患者110例,年龄20~40岁,ASA分级Ⅰ、Ⅱ级,采用随机数字表法将患者分为2组(每组55例):丙泊酚无痛取卵组(P组)和布洛芬组(C组)。术前收集患者一般临床资料,患者入室后监护生命体征,建立静脉通路。P组麻醉诱导方法为静脉缓慢推注丙泊酚2.0~2.5 mg/kg,待患者Ramsay镇静评分达6分后开始手术,丙泊酚8~12 mg·kg^(-1)·h^(-1)静脉泵注维持麻醉;C组术前15 min于阴道深部置入布洛芬栓剂。记录两组患者年龄、BMI、不孕年限、手术时间、ASA分级、所用超促排卵用药的天数、促排卵用药总量、基础卵泡刺激素(follicle-stimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)、雌二醇(estradiol,E2)水平。观察并记录患者在麻醉诱导前(T_(0))、手术开始即刻(T_(1))、手术结束即刻(T_(2))、术后10 min(T_(3))4个时间点的MAP、心率、SpO2,T_(3)时的VAS疼痛评分及不良反应发生情况;收集T_(0)、T_(2)、术后第1天晨(T_(4))、胚胎移植前(T_(5))静脉血,利用流式细胞仪检测NK细胞数量;记录两组患者妊娠结局情况。结果P组MAP、心率在T_(1)、T_(2)、T_(3)时低于C组(P<0.05)。与T_(0)比较:P组MAP及心率在T_(1)时升高,T_(3)时降低(P<0.05);C组MAP及心率在T_(1)、T_(2)、T_(3)时均升高(P<0.05)。两组患者各时点SpO2比较,差异无统计学意义(P>0.05)。P组T_(3)时VAS疼痛评分低于C组,术中体动例数少于C组(P<0.05)。两组患者呼吸抑制及术后恶心呕吐例数比较,差异无统计学意义(P>0.05)。P组T_(2)时NK细胞数量少于C组(P<0.05);与T_(0)比较,P组T_(2)时NK细胞数量减少(P<0.05)。两组患者受精卵形成率、胚胎形成率、早期流产率、临床妊娠率比较,差异无统计学意义(P>0.05);P组获卵数、获卵率Objective To evaluate the effects of intravenous anesthesia with propofol on the number of natural killer(NK)cells and pregnancy outcome of patients undergoing oocyte retrieval.Methods According to the random number table method,110 patients,aged 20 to 40 years,American Society of Anesthesiologists(ASA)ⅠorⅡ,who were scheduled for in vitro fertilization and embryo transfer(IVF-ET)were enrolled and divided into two groups(n=55):a propofol group(group P)and a ibuprofen group(group C).Their general clinical data were collected before operation;the vital signs were monitored after entry into the operating room and venous access was established.Group P was intravenously infused with 2.0‒2.5 mg/kg of propofol and the operation started when the score of sedation reached 6,with anesthesia maintenance with propofol at 8‒12 mg·kg^(−1)·h^(−1).Group C was vaginally placed with ibuprofen suppository 15 min before operation.Then,their age,body mass index(BMI),the duration of infertility,operation time,ASA grades,the days of superovulation,total dose of ovulation induction,and the levels of basal follicle-stimulating hormone(FSH),luteinizing hormone(LH)and estradiol(E2)were recorded.The mean arterial pressure(MAP),heart rate and pulse oxygen saturation(SpO2)were recorded before anesthesia induction(T_(0)),immediately after operation(T_(1)),immediately after operation(T_(2))and 10 min after operation(T_(3)),VAS scores at T_(3) and adverse reactions were recorded.The venous blood samples were collected at T_(0),T_(2),day 1 after operation(T_(4))and before embryo transfer(T_(5))to measure the number of NK cells by flow cytometry.Their pregnancy outcomes were recorded.Results MAP and heart rate in group P were lower than those in group C at T_(1),T_(2) and T_(3)(P<0.05).Compared with those at T_(0),MAP and heart rate in group P increased at T_(1) and decreased at T_(3)(P<0.05),and MAP and heart rate in group C increased at T_(1),T_(2) and T_(3)(P<0.05).There was no statistical difference in SpO2 at each time point betw

关 键 词：丙泊酚 妊娠结局 自然杀伤细胞 取卵术 体外受精胚胎移植术 

分 类 号：R614[医药卫生—麻醉学]