纳布啡在超声引导下经阴道穿刺取卵术中的应用及对胚胎质量和妊娠结局的影响  

Application of nalbuphine in ultrasound-guided transvaginal oocyte retrieval and its effect on embryo quality and pregnancy outcome

作　　者：刘馨 冷玉芳[2,3] 张学红[1,2] 张莉莉[1,2] 张梦婕[3] 瞿珊珊 谢建琴 王一青 LIU Xin;LENG Yufang;ZHANG Xuehong;ZHANG Lili;ZHANG Mengjie;QU Shanshan;XIE Jianqin;WANG Yiqing(Reproductive Medicine Center,The First Hospital of Lanzhou University,Lanzhou 730000,Gansu,China;The First Clinical Medical College of Lanzhou University,Lanzhou 730000,Gansu,China;Department of Anesthesiology,The First Hospital of Lanzhou University,Lanzhou 730000,Gansu,China;Department of Anesthesiology,The Second Hospital of Lanzhou University,Lanzhou 730000,Gansu,China)

机构地区：[1]兰州大学第一医院生殖医学中心,甘肃兰州730000 [2]兰州大学第一临床医学院,甘肃兰州730000 [3]兰州大学第一医院麻醉科,甘肃兰州730000 [4]兰州大学第二医院麻醉科,甘肃兰州730000

出　　处：《中国临床药理学与治疗学》2021年第9期1042-1047,共6页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：国家自然科学基金(81960624);陈孝平科技发展基金会围术期镇痛药研究纳布啡专项基金(CXPJJH118000017-02-01);甘肃省自然科学基金(20JR10RA696);甘肃省自然科学基金(21JR1RA067);兰州大学第一医院院内基金(ldyyyn2019-59);甘肃省高等学校创新基金项目(2021B-012)。

摘　　要：目的:观察纳布啡用于超声引导下经阴道穿刺取卵术患者的麻醉效果及其对胚胎质量和妊娠结局的影响。方法:选取行超声引导下经阴道穿刺取卵术的患者400例,随机分为两组(n=200):纳布啡组(N组)和对照组(C组)。患者入室后取膀胱截石位,N组于麻醉诱导前2 min,静注纳布啡0.1 mg/kg,C组静注等容量生理盐水,两组以1.5 mg/kg丙泊酚进行麻醉诱导,保留患者自主呼吸,术中静注丙泊酚2 mg·kg^(-1)·h^(-1)+瑞芬太尼0.1μg·kg^(-1)·min^(-1)维持麻醉。记录两组患者麻醉诱导前(T_(0))、麻醉诱导后(T_(1))、穿刺取卵即刻(T_(2))、苏醒时(T_(3))的心率(HR)、平均动脉压(MAP)和脉搏血氧饱和度(SpO_(2));手术时间和麻醉苏醒时间,丙泊酚和瑞芬太尼用量及患者术毕40 min的视觉模拟评分(VAS);术中呼吸抑制、体动、辅助呼吸和术后恶心呕吐等不良反应发生情况及术毕医、患满意度;胚胎质量及妊娠结局相关指标。结果:与T_(0)时比较,T_(1)、T_(2)、T_(3)时,两组患者的HR减慢,MAP和SpO_(2)降低(P<0.05)。与C组比较,T_(1)、T_(2)、T_(3)时,N组的MAP和SpO_(2)较高(P<0.05),N组手术时间和麻醉苏醒时间更短(P<0.05),丙泊酚和瑞芬太尼用量更少(P<0.05),术后40 min的VAS评分更低(P<0.05);术中呼吸抑制、体动、辅助呼吸和术后恶心呕吐等不良反应更低(P<0.05),医、患满意度更高(P<0.05);胚胎质量和妊娠结局相关指标两组比较差异无统计学意义(P>0.05)。结论:0.1 mg/kg纳布啡联合丙泊酚及瑞芬太尼用于超声引导下经阴道穿刺取卵术的患者,麻醉过程平稳,镇痛效果确切,医、患满意度高,不良反应发生率低,且不影响辅助生殖患者的胚胎质量及妊娠结局,值得临床推广应用。AIM:To observe the anesthetic effect of nalbuphine used in ultrasound-guided transvaginal oocyte retrieval and its effect on embryo quality and pregnancy outcome.METHODS:Four-hundred patients who underwent ultrasound-guided transvaginal oocyte retrieval were randomly divided into two groups(n=200):nalbuphine group(N group)and control group(C group).The patients were in the bladder lithotomy position.Patients in N group were given nalbuphine 0.1 mg/kg intravenously 2 minutes before induction of anesthesia,patients in C group were given normal saline intravenously,and patients in both groups were induced with propofol 1.5 mg/kg.The patients were kept breathing spontaneously,and they were given intravenous injections of propofol(2 mg·kg^(-1)·h^(-1))and remifentanil(0.1μg·kg^(-1)·min^(-1))during the operation to maintain anesthesia.Heart rate(HR),mean arterial pressure(MAP)and pulse oxygen saturation(SpO_(2))were recorded before anesthesia induction(T_(0)),after anesthesia induction(T_(1)),at time of puncture oocytes(T_(2)),and wake from anesthesia(T_(3)).The operation time,anesthesia recovery time,intraoperative dosage of propofol,dosage of remifentanil and VAS score were recorded.The incidence of respiratory depression,body movement,assisted breathing,postoperative nausea and vomiting and other adverse reactions,as well the satisfaction of doctors and patients after surgery were compared.Embryonic quality and pregnancy outcome related indexes were also recorded.RESULTS:Compared with T_(0),HR slowed down and MAP and SpO_(2)decreased at T_(1),T_(2)and T_(3)(P<0.05).Compared with C group,MAP and SpO_(2)in N group were higher at T_(1),T_(2)and T_(3)(P<0.05),the operation time and anesthesia recovery time were shorter in N group(P<0.05),the dosage of propofol and remifentanil was less(P<0.05),the VAS score 40 min after surgery was lower(P<0.05).Intraoperative respiratory depression,body movement,assisted breathing and postoperative nausea and vomiting were lower(P<0.05),the satisfaction of doctors and patients was

关 键 词：纳布啡 体外受精-胚胎移植 超声引导下经阴道穿刺取卵术 胚胎质量 妊娠结局 

分 类 号：R614[医药卫生—麻醉学] R714[医药卫生—外科学]