阿芬太尼与纳布啡复合丙泊酚用于生殖中心取卵手术的效果比较  

Effects of alfentanil and nalbuphine combined with propofol in patients undergoing oocyte retrieval in reproductive center

作　　者：陈方薇 庹鹏 揭英锡 王寿平[1] Chen Fangwei;Tuo Peng;Jie Yingxi;Wang Shouping(Department of Anesthesiology,The Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,China)

机构地区：[1]广州医科大学附属第三医院麻醉科,广州510150

出　　处：《国际医药卫生导报》2023年第9期1228-1234,共7页International Medicine and Health Guidance News

基　　金：广东省科技厅基础与应用基础面上项目(2021A1515220002);广州市科技局市校联合项目(202201020389);广州市卫生健康科技项目(20221A011093);荔湾区科技计划重点卫生科研项目(202201011)。

摘　　要：目的探讨不同剂量阿芬太尼复合丙泊酚用于生殖中心取卵手术的安全性和有效性。方法本研究为随机双盲对照试验。选取2021年6—12月于广州医科大学附属第三医院生殖中心行取卵手术的患者200例,年龄22~40岁,美国麻醉医师协会(ASA)分级Ⅰ级,随机分为4组,每组50例:对照组(C组)、纳布啡组(N组)、阿芬太尼1组(A1组)、阿芬太尼2组(A2组)。N组手术开始5 min前静脉注射纳布啡0.1 mg/kg,A1组手术开始3 min前静脉注射阿芬太尼5μg/kg,A2组静脉注射阿芬太尼10μg/kg,3组用药均稀释至20 ml,C组予以等量生理盐水;4组患者均静脉注射托烷司琼4.48 mg,卵巢穿刺开始前静脉注射丙泊酚2 mg/kg,术中若出现体动,则追加丙泊酚0.5 mg/kg。观察患者在入室时(T_(0))、静脉注射阿芬太尼或纳布啡后1 min(T_(1))、麻醉诱导后(T_(2))、手术过程中(T_(3))、苏醒时(T_(4))、术后5 min(T_(5))、术后30 min(T6)的心率(HR)、平均动脉压(MAP)以及脉搏血氧饱和度(SpO_(2))的变化,对比4组患者丙泊酚使用量、手术时间、苏醒时间、离院时间以及术中体动发生率,对比4组患者术后各个时间点(T_(4)~T6)的视觉模拟评分法(VAS)评分、Ramsay镇静评分,术后当天随访患者腹痛情况,有无恶心呕吐、嗜睡、头晕、皮肤瘙痒等不良反应的发生,随访术后活动情况。统计学方法采用单因素方差分析、Kruskal-Wallis检验、Mann-Whitney检验、χ^(2)检验。结果4组患者各个时间点的HR、SpO_(2)比较差异均无统计学意义(均P>0.05),4组患者均未出现SpO_(2)低于0.90的情况。A1、A2组苏醒时间均短于C组、N组,体动次数均少于C组、N组(均P<0.05);C组丙泊酚用量均高于其余3组(均P<0.05)。在T_(3)时,C组患者的MAP均低于其余3组(均P<0.05)。A1、A2组在T6与术后6 h的VAS评分均低于C组(均P<0.05)。A1组在T_(4)、T_(5)、T6时的嗜睡发生率均低于C组[22.0%(11/50)比52.0%(26/50)、18.0%(9/50)比38.0%(19/50)、0Objective To compare the safety and efficacies of different doses of alfentanil combined with propofol in patients undergoing oocyte retrieval under general anesthesia in reproductive center.Methods It was a randomized double-blind controlled trial.From June 2021 to December 2021,a total of 200 patients who underwent oocyte retrieval under general anesthesia in Department of Anesthesiology,The Third Affiliated Hospital of Guangzhou Medical University,aged 22-40 years,with American Society of Anesthesiologists(ASA)grade I,were randomly divided into 4 groups with 50 cases in each group:the control group(group C),nalbuphine group(group N),alfentanil group 1(group A1),and alfentanil group 2(group A2).Group N was intravenously injected with 0.1 mg/kg of nalbuphine 5 min before surgery,group A1 was intravenously injected with 5μg/kg of afentanil and group A2 with 10μg/kg of afentanil 3 min before surgery,diluted to 20 ml in all the 3 groups,and group C was given the equivalent volume of normal saline.All patients in the 4 groups were given 4.48 mg of tropisetron intravenously,2 mg/kg of propofol intravenously before ovarian puncture,and 0.5 mg/kg of propofol was added if body movement occurred during surgery.At time of entering the room(T_(0)),1 min after intravenous injection of alfentanil or nalbuphine(T_(1)),after induction of anesthesia(T_(2)),during procedure(T_(3)),at recovery(T_(4)),5 min after surgery(T_(5)),and 30 min after surgery(T6),the 4 groups were recorded for changes in heart rate(HR),mean arterial pressure(MAP),and pulse oxygen saturation(SpO_(2)).The propofol use,operation time,recovery time,discharge time,intraoperative body movement,and Visual Analogue Scale(VAS)scores and Ramsay sedation scores from T_(4) to T6 were compared among the 4 groups.The patients were followed up for adverse reactions such as abdominal pain,nausea and vomiting,drowsiness,dizziness,and skin itching on the day after surgery,and the physical mobility was observed.One-way analysis of variance,Kruskal-Wallis test,Mann-Whitne

关 键 词：阿芬太尼 纳布啡 取卵手术 舒适化医疗 

分 类 号：R614[医药卫生—麻醉学]