Abstract:

Objective　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 5 µg/kg of afentanil and group A2 with 10 µg/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 (T₀), 1 min after intravenous injection of alfentanil or nalbuphine (T₁), after induction of anesthesia (T₂), during procedure (T₃), at recovery (T₄), 5 min after surgery (T₅), 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 (SpO₂). The propofol use, operation time, recovery time, discharge time, intraoperative body movement, and Visual Analogue Scale (VAS) scores and Ramsay sedation scores from T₄ 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-Whitney test, and χ² test were used for statistical analysis. Results　There were no statistically significant differences in the HR and SpO₂ among the 4 groups at each time point (all P>0.05), and no patients in the 4 groups had SpO₂ below 0.90. The recovery time of group A1 and A2 were shorter than those of group C and N, and the numbers of body movement were lower than those of group C and N (all P<0.05). The propofol use in group C was higher than those in the other 3 groups (all P<0.05). At T₃, the MAP in group C was lower than those in the other 3 groups (all P<0.05). The VAS scores of group A1 and A2 at T₆ and 6 h after surgery were lower than those of group C (all P<0.05). The incidences of drowsiness in group A1 at T₄, T₅, and T₆ were lower than those in group C [22.0% (11/50) vs. 52.0% (26/50), 18.0% (9/50) vs. 38.0% (19/50), 0 vs. 20.0% (10/50)], and the incidence of drowsiness in group N at T₄ was lower than that in group C [32.0% (16/50) vs. 52.0% (26/50)], with statistically significant differences (all P<0.05). The incidence of drowsiness in group A2 at T₄ [52.0% (26/50)], T₅ [48.0% (24/50)], and T₆ [20.0% (10/50)] were higher than those in group A1 (all P<0.05). The incidences of dizziness in group N at T₄ and T₅ were higher than those in the other 3 groups (all P<0.05). The incidences of nausea and vomiting in group N at T₅ and T₆ were higher than those in the other 3 groups (all P<0.05). Conclusions　Alfentanil combined with propofol can be used in patients undergoing oocyte retrieval under general anesthesia in reproductive center. The recommended dose of 5 µg/kg is effective for analgesia without affecting the patients' postoperative recovery, with few adverse reactions.

Key words:

Alfentanil, Nalbuphine, Oocyte retrieval, Comfortable medical treatment

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5 µg/kg，A2组静脉注射阿芬太尼10 µg/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（T₀）、静脉注射阿芬太尼或纳布啡后1 min（T₁）、麻醉诱导后（T₂）、手术过程中（T₃）、苏醒时（T₄）、术后5 min（T₅）、术后30 min（T₆）的心率（HR）、平均动脉压（MAP）以及脉搏血氧饱和度（SpO₂）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（T₄～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、χ²检验。结果　4组患者各个时间点的HR、SpO₂比较差异均无统计学意义（均P>0.05），4组患者均未出现SpO₂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T₃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T₄、T₅、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）、0比20.0%（10/50）］，N组在T₄时的嗜睡发生率低于C组［32.0%（16/50）比52.0%（26/50）］，差异均有统计学意义（均P<0.05）；A2组在T₄［52.0%（26/50）］、T₅［48.0%（24/50）］、T₆［20.0%（10/50）］时的嗜睡发生率均高于A1组（均P<0.05）。N组在T₄、T₅的头晕发生率均高于其余3组（均P<0.05）；N组在T₅、T₆的恶心呕吐发生率均高于其余3组（均P<0.05）。结论　阿芬太尼复合丙泊酚用于生殖中心取卵手术安全有效，以5 µg/kg为推荐剂量，在有效镇痛的同时，患者术后恢复快，不良反应少。

关键词:

阿芬太尼, 纳布啡, 取卵手术, 舒适化医疗