经阴道超声引导取卵术的麻醉进展与安全性  

Progress and safety in anesthesia for transvaginal ultrasound-guided oocyte retrieval surgery

作　　者：傅润乔 刘家恩 方蔚然 杨晓明 FU Runqiao;LIU Jiaen;FANG Weiran;YANG Xiaoming(Department of Anesthesiology,Airforce Medical Center,Beijing 100142;Reproductive Medical Center,Beijing Jiaen De Yun Hospital,Beijing 10091;Department of Gynaecology and Obstetrics,Airforce Medical Center,Beijing 100142,China)

机构地区：[1]空军特色医学中心麻醉科,北京100142 [2]北京家恩德运医院生殖中心,北京100191 [3]空军特色医学中心妇产科,北京100142

出　　处：《麻醉安全与质控》2024年第4期234-240,共7页Perioperative Safety and Quality Assurance

基　　金：空委后勤保障部卫生局应用基础研究面上项目(23JSZ06)。

摘　　要：体外受精-胚胎移植(IVF-ET)技术,经阴道超声引导取卵术(TVUOR)患者的疼痛与焦虑非常明显并影响妊娠结局。其镇痛方法经历了早期的非麻醉医生介入和现今的常规麻醉医生介入达到完全无痛全麻。即从肌注止痛药、吸入氧化亚氮、肛门塞入止痛栓、穴位针刺镇痛、静脉小剂量咪达唑仑/右美托咪定/芬太尼复合的清醒镇静镇痛麻醉,到目前以丙泊酚为主、麻醉性镇痛药(阿片类药)为辅的全凭静脉麻醉。本文引述了临床常用的阿片类药与丙泊酚复合的麻醉方法与效果,及对妊娠结局的影响,以及卵泡液中的丙泊酚可能对卵子质量的不利影响。减少丙泊酚消耗量和缩短手术时间是改进方向。目前芬太尼类或具有κ受体的激动剂辅助丙泊酚静脉全麻在TVUOR中可能是较合适的选择。For patients receiving in vitro fertilization-embryo transfer(IVF-ET)treatment,the pain and anxiety during transvaginal ultrasound-guided oocyte retrieval(TVUOR)are very serious and affect pregnancy outcomes.The analgesic methods had undergone early intervention by non-anesthesiologists and current routine anesthesiologists to achieve completely painless general anesthesia.It is a gradual process from intramuscular injection of analgesics,inhalation of N 2O,insertion of painkillers into the anus,acupuncture analgesia,intravenous low-dose midazolam/dexmedetomidine/fentanyl combination for conscious sedative and analgesic anesthesia,to now total intravenous anesthesia with propofol as the main component and narcotic analgesics(opioids)as auxiliary.The anesthesia methods and effects of commonly used opioid drugs combined with propofol in clinical practice were cited and introduced,as well as their impact on pregnancy outcomes.Propofol in follicular fluid may have adverse effects on oocytes quality.Improving anesthesia technique to reduce propofol consumption and shorten surgical time to avoid prolonged use of propofol is an effort to be made.At present,fentanyl series orκreceptor agonists may be more suitable for assisting propofol intravenous general anesthesia in TVUOR.

关 键 词：经阴道超声引导下取卵术 麻醉 丙泊酚 毒性 

分 类 号：R614[医药卫生—麻醉学]