Application Of Nalbuphine In Ultrasound-guided Transvaginal Oocyte Retrieval And Its Effect On Embryo Quality And Pregnancy Outcome

Objective:To evaluate the anesthetic effect of nalbuphine combined with propofol and remifentanil in patients with ultrasound-guided transvaginal oocyte retrieval（UGTOR）and its effects on embryo quality and pregnancy outcome.It is expected to provide a more safer and effective anesthesia scheme for the perioperative pain management of painless UGTOR in infertile patients and provide a clinical reference for the positive role of intravenous anesthesia in pregnancy safety.Methods:From June 2019 to December 2019,440 UGTOR patients who voluntarily received intravenous anesthesia in Reproductive Medicine Center,First Hospital of Lanzhou University were randomly divided into two groups（n=220）:Propofol+remifentanil group（P group）,0.1 mg/kg nalbuphine+propofol+remifentanil group（N group）.Two minutes before anesthesia induction,the N group was intravenously injected with 0.1 mg/kg nalbuphine,P group was injected with the same volume of normal saline.Intravenous injection of propofol 1.5 mg/kg was used for anesthesia induction in both groups,and spontaneous breathing was retained.Intraoperative anesthesia was maintained with propofol 2 mg/（kg·h）and remifentanil0.1μg/（kg·min）.Heart rate（HR）,mean arterial pressure（MAP）,and pulse oxygen saturation（Sp O₂）were recorded before anesthesia induction（T₀）,immediately after anesthesia induction（T₁）,puncture oocytes immediately（T₂）,when awake from anesthesia（T₃）in two groups.The operation time,anesthesia recovery time,intraoperative propofol and remifentanil dosage and VAS score of patients 40 min after surgery were recorded.The adverse reactions such as respiratory depression,body movement,assisted respiration and PONV were recorded.The satisfactions of doctors and patients with anesthesia were recorded.The number of oocyte obtained,M-II oocyte rate,2PN rate,excellent embryo rate,clinical pregnancy rate,early abortion rate and live birth rate were recorded.Results:Compared with T₀,HR slowed down and MAP and Sp O₂ decreased at T₁,T₂ and T₃（P<0.05）.Compared with P group,MAP and Sp O₂ 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 dosages of propofol and remifentanil were less（P<0.05）,the VAS score 40 min after surgery was lower（P<0.05）,the incidences of postoperative adverse reactions such as respiratory depression,body movement,assisted respiration and PONV were lower（P<0.05）,the satisfaction of doctors and patients were higher（P<0.05）.There were no significant differences in the number of oocytes obtained,M-II oocyte rate,2PN rate,excellent embryo rate,pregnancy rate,abortion rate and live birth rate between the two groups（P>0.05）.Conclusion:0.1 mg/kg nalbuphine combined with propofol and remifentanil were used for UGTOR patients,the anesthesia process was more stable,the operation time and anesthesia recovery time were shorter,the dosages of propofol and remifentanil were less,the postoperative analgesia effect was more accurate,the incidence of adverse reactions was lower,the satisfaction of doctors and patients were higher.Moreover,it has no adverse effect on the embryo quality and pregnancy outcome of UGTOR patients.