慢性盆腔痛疼痛阈值测定及临床意义研究

Determination and clinical significance of the pain threshold in women with chronic pelvic pain

目的探讨健康女性和慢性盆腔痛患者的腹部、外阴、盆底肌群及双侧附件、子宫骶骨韧带的压力性疼痛阈值,并分析其变化对于慢性盆腔痛患者的意义。方法选取2009年1月至2015年9月大连市妇女儿童医疗中心100例健康女性(对照组)和324例慢性盆腔痛患者(观察组)。填写专门的资料收集表格,并应用全自动体表和阴道压力痛觉检测计以0.5 kg/(cm2·s)的速度检测上述两组人群的腹部(14个)、外阴(6个)、盆底肌群(8个)和阴道前后穹窿、双侧附件、子宫骶骨韧带(6个)等34个检测点的疼痛阈值(kg/cm2);分析两组各个检测点的疼痛阈值差异。结果观察组尿失禁、盆腔器官脱垂、痛经、子宫内膜异位症、肠易激惹综合征及间质性膀胱炎的发病率明显高于对照组(P<0.05);观察组腹部、外阴、盆底及阴道前后穹窿、双侧附件、子宫骶骨韧带检测点的平均疼痛阈值(1.57±0.40,0.93±0.41,1.01±0.54,1.11±0.33,0.73±0.30,1.03±0.43)均明显低于对照组(1.78±0.47,1.19±0.42,1.78±0.69,1.44±0.45,1.59±0.52,1.49±0.50)(P<0.05)。结论慢性盆腔痛可能与其腹部、会阴、阴道及盆底的疼痛阈值降低、疼痛敏感性增加有关。

Objective To study the threshold of pain on pressure in abdomen, vulva, pelvic floor muscles, bilateral ac- cessories and uterine sacrum ligament in healthy women and patients with chronic pelvic pain, and to analyze its signifi- cance. Methods Totally 100 healthy women （control group） and 324 women with chronic pelvic pain （experimental group） were chosen. The specialized forms were filled to collect data. Automatic detectors of pain on pressure for body surface and vagina were applied to detect the pain threshold at the speed 0.5kg/（cm2·s） on 34 spots, which were in abdo- men （14）, vulva （6）, pelvie floor museles （8） and vaginal front and back fornix, bilateral accessories and uterine sacrum ligament （6）（kg/cm2）. The differences of pain threshold on various spots between the two groups were analyzed.Results The incidence of urinary incontinence, pelvic organ prolapse, dysmenorrhea, endometriosis, irritable bowel syndrome and symptoms of interstitial cystitis in the experimental group was significantly higher than that in control group （P〈 0.05）. The average pain threshold detected in abdomen, vulva, pelvic floor, vaginal front and back fornix, bilateral acces- sories and uterine sacrum ligament in experimental group （1.57±0.40; 0.93 ± 0.41 ; 1.01± 0.54; 1.11± 0.33 ; 0.73 ± 0.30; 1.03±0.43） were signifieantly lower than that in the eontrol group （1.78±0.47; 1.19±0.42; 1.78±0.69; 1.44± 0.45; 1.59 ± 0.52; 1.49±0.50） （P〈 0.05）.Conclusion Female ehronie pelvie pain may be related to the drop of pain threshold and the raise of pain sensitivity in abdomen, perineum, vagina and pelvic floor.