标题：纳布啡复合丙泊酚及瑞芬太尼对 IVF-ET患者的麻醉效果及胚胎质量和妊娠结局的影响

      作者：杨平鸽 1，魏晓磊 2，马小凤 1    1.西安安琪儿妇产医院麻醉科，陕西 西安 710004；2.西安未央德雅正尚口腔门诊部麻醉科，陕西 西安 710000

      卷次： 2023年34卷24期

      【摘要】 目的 探讨纳布啡复合丙泊酚及瑞芬太尼在体外受精-胚胎移植技术(IVF-ET)患者中的应用效果及对胚胎质量和妊娠结局的影响。方法 选择2021年12月至2022年3月在西安安琪儿妇产医院拟行取卵术的120例IVF-ET患者作为研究对象，根据随机数表法将患者分为对照组和研究组，每组60例。对照组患者采用丙泊酚及瑞芬太尼麻醉，研究组患者在对照组的基础上复合纳布啡。比较两组患者麻醉诱导前(T1)、手术开始时(T2)、手术结束后(T3)的心率(HR)与平均动脉压(MAP)，比较两组患者术后2 h的不良反应发生率、视觉模拟评分法(VAS)评分及移植5周后的妊娠结局。结果 T1时，两组患者的MAP、HR水平比较差异均无统计学意义(P>0.05)；T2与T3时，研究组患者的MAP、HR水平分别为(86.92±7.65) mmHg、(86.50±7.87)次/min与(82.35±6.96) mmHg、(76.75±7.63)次/min，明显低于对照组的(92.23±7.45) mmHg、(90.90±9.47)次/min与(91.30±5.29) mmHg、(85.54±7.72)次/min，差异均有统计学意义(P<0.05)；两组患者的呼吸抑制、术后恶心呕吐发生率比较差异均无统计学意义(P>0.05)；研究组患者的术中体动发生率、术后VAS评分分别为13.33%、(1.38±0.22)分，明显低于对照组的40.00%、(3.59±0.78)分，差异均具有统计学意义(P<0.05)；研究组患者的获卵数、获卵率分别为(13.25±3.41)个、(72.50±17.45)%，明显高于对照组的(9.23±2.65)个、(64.32±16.76)%，差异均有统计学意义(P<0.05)；两组患者的优质胚胎率、受精卵形成率、临床妊娠率比较差异均无统计学意义(P>0.05)。结论 纳布啡复合丙泊酚及瑞芬太尼无痛取卵术应用于 IVF-ET患者中可维持血流动力学稳定，降低不良反应及术后疼痛度，且不会影响妊娠结局，可在临床推广应用。
      【关键词】 体外受精-胚胎移植技术；纳布啡；丙泊酚；瑞芬太尼；无痛取卵术；血流动力学；不良反应；妊娠结局
      【中图分类号】 R715 【文献标识码】 A 【文章编号】 1003—6350（2023）24—3596—04

Effects of nalbuphine combined with propofol and remifentanil on anesthetic effect, embryo quality andpregnancy outcome in patients undergoing in vitro fertilization-embryo transfer.
YANG Ping-ge 1, WEI Xiao-lei 2,MA Xiao-feng 1. 1. Department of Anesthesiology, Xi'an Angel Women's and Children Hospital, Xi'an 710004, Shaanxi,CHINA; 2. Department of Anesthesiology, Xi'an Weiyang Deya Zhengshang Dental Clinic, Xi'an 710000, Shaanxi, CHINA
【Abstract】 Objective To investigate the application effect of nalbuphine combined with propofol and remifent-anil in patients undergoing in vitro fertilization-embryo transfer (IVF-ET) and its effect on embryo quality and pregnancyoutcome. Methods A total of 120 IVF-ET patients undergoing oocyte retrieval in Xi'an Angel Women's and ChildrenHospital from December 2021 to March 2022 were selected as the study objects. The patients were divided into a controlgroup and a study group according to random number table method, with 60 patients in each group. The patients in thecontrol group were anesthetised with propofol and remifentanil, and the patients in the study group additionally used nal-buphine on the basis of the control group. The heart rate (HR) and mean arterial pressure (MAP) before anesthesia induc-tion (T1), at the beginning of operation (T2) and after operation (T3) were compared between the two groups. The inci-dence of adverse reactions 2 h after operation, Visual Analogue Scale (VAS) score, and pregnancy outcome 5 weeks aftertransplantation were compared between the two groups. Results At T1, there were no significant difference in MAPand HR levels between the two groups (P>0.05). At T2 and T3, MAP and HR levels in the study group were (86.92±7.65) mmHg, (86.50±7.87) times /min and (82.35±6.96) mmHg, (76.75±7.63) times /min, which were significantly low-er than (92.23±7.45) mmHg, (90.90±9.47) times /min and (91.30±5.29) mmHg, (85.54±7.72) times /min in the controlgroup (P<0.05). There were no significant difference in the incidence of respiratory depression, postoperative nausea andvomiting between the two groups (P>0.05). The intraoperative body movement incidence and postoperative VAS score inthe study group were 13.33% and (1.38±0.22) points, which were significantly lower than 40.00% and (3.59±0.78) pointsin the control group (P<0.05). The number and rate of oocytes retrieved in the study group were 13.25±3.41 and (72.50±17.45)%, which were significantly higher than 9.23±2.65 and (64.32±16.76)% in the control group (P<0.05). There wasno significant difference in high-quality embryo rate, formation rate of fertilized egg, and clinical pregnancy rate be-tween the two groups (P>0.05). Conclusion The application of nalbuphine combined with propofol and remifentanil inpainless oocyte retrieval in IVF-ET patients can maintain hemodynamic stability, reduce adverse reactions and postopera-tive pain, and will not affect pregnancy outcome, which can be promoted and applied in clinical practice.
      【Key words】 In vitro fertilization-embryo transfer technology; Nabulphine; Propofol; Remifentanil; Painless oo-cyte retrieval; Hemodynamics; Adverse reaction; Pregnancy outcome