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

Abstract: 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 (0.1 μg·kg-1·min-1) during the operation to maintain anesthesia. Heart rate (HR), mean arterial pressure (MAP) and pulse oxygen saturation (SpO2) were recorded before anesthesia induction (T0), after anesthesia induction (T1), at time of puncture oocytes (T2), and wake from anesthesia (T3). 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 T0, HR slowed down and MAP and SpO2 decreased at T1, T2 and T3 (P<0.05). Compared with C group, MAP and SpO2 in N group were higher at T1, T2 and T3 (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 higher (P<0.05). There was no significant difference in embryo quality and pregnancy outcome between the two groups (P>0.05). CONCLUSION: 0.1 mg/kg nalbuphine combined with propofol and remifentanil used in ultrasound-guided transvaginal oocyte retrieval patients reveals stable anesthesia process and definite analgesic effect. The satisfaction of doctors and patients is high while the incidence of adverse reactions is low. Also, it does not affect the embryo quality and pregnancy outcome of assisted reproduction patients, which is worthy of clinical promotion and application.

Key words: nalbuphine, in vitro fertilization-embryo transfer, ultrasound-guided transvaginal oocyte retrieval, embryo quality, pregnancy outcome