原发性痛经与继发性痛经非手术识别方法探讨

Non-operative Identification of Primary and Secondary Dysmenorrhea

目的探讨痛经患者的临床特征,为原发性痛经与继发性痛经的非手术识别方式提供参考。方法对336例痛经的临床特征进行分析,比较原发性痛经与继发性痛经患者的疼痛特点。结果原发性痛经80例,继发性痛经256例,初潮出现痛经的比例分别为25.0%(20/80)、30.1%(77/256),无统计学差异(χ2=0.765,P=0.382)。继发性痛经组患者疼痛VAS(7.9±1.8)分,显著高于原发性痛经组(7.4±1.8)分(t=-2.169,P=0.031),痛经加重的比例56.6%(145/256)显著高于原发性痛经组患者38.8%(31/80)(χ2=7.821,P=0.004)。继发性痛经组患者合并消化、泌尿系统伴随症状的比例为69.5%(178/256),显著高于原发性痛经组43.8%(35/80)(χ2=17.458,P=0.000),非甾体类抗炎药的疼痛缓解率为65.5%(78/119),显著低于原发性痛经组89.6%(26/29)(χ2=6.488,P=0.011)。结论原发性痛经与继发性痛经均可于初潮出现,痛经严重、疼痛持续加重、有伴随症状、非甾体类抗炎药治疗无效的患者,应注意继发性痛经的识别。

Objective To observe the clinical characteristics of patients with dysmenorrhea and to provide basis for nonoperative identification of primary and secondary dysmenorrhea. Methods The clinical features and pain characteristics of 336 patients with dysmenorrhea were analyzed. Results Eighty patients were diagnosed as having primary dysmenorrhea and 256 patients were diagnosed as having secondary dysmenorrhea. The dysmenorrhea at menarche occurred in 25. 0%（ 20 /80） of primary and30. 1%（ 77 /256） of secondary dysmenorrhea patients,with no significant differences（ χ2= 0. 765,P = 0. 382）. As compared with primary dysmenorrhea group,the secondary dysmenorrhea group showed more severe pain（ 7. 9 ± 1. 8 vs. 7. 4 ± 1. 8,t =- 2. 169,P = 0. 031）,higher percentages of aggravated dysmenorrhea [56. 6%（ 145 /256） vs. 38. 8%（ 31 /80）,χ2= 7. 821,P = 0. 004 ],higher percentages of accompany symptoms [69. 5%（ 178 /256） vs. 43. 8%（ 35 /80）,χ2= 17. 458,P = 0. 000 ],and lower relief rate to regular treatment [65. 5%（ 78 /119） vs. 89. 6%（ 26 /29）,χ2= 6. 488,P = 0. 011 ],respectively. Conclusions Both primary and secondary dysmenorrhea could occur at menarche. Patients with severe and aggravated dysmenorrhea, accompany symptoms,and low routine medical treatment efficiency should be paid more attention of secondary dysmenorrhea.