实时三维子宫输卵管造影的不良反应与处理

Adverse Reactions and Management of Real-time Three-dimensional Hysterosalpingo-contrast Sonography

目的探讨经阴道实时三维子宫输卵管造影(3D-Hy Co Sy)过程中不良反应及处理措施。资料与方法回顾性分析2014年12月-2016年8月南京中医药大学附属江苏省中医院976例因不孕症就诊行3D-Hy Co Sy的患者。采用视觉模拟评分法(VAS)进行疼痛程度评估,同时记录患者造影剂逆流、呕吐、晕厥、过敏等发生情况,比较不同超声表现患者的不良反应情况。结果疼痛VAS评分0级66例(6.76%)、轻度疼痛346例(35.45%)、中度疼痛374例(38.32%)、重度疼痛190例(19.47%)。随着输卵管阻塞程度的增加,疼痛程度逐渐加重,并成为患者最常见的不良反应;其次呕吐15例(1.54%)、晕厥1例(0.10%)、过敏1例(0.10%)、造影剂逆流120例(12.30%)。超声表现异常患者不良反应发生率明显高于超声表现正常者,差异有统计学意义(χ~2=29.02,P<0.01)。结论 3D-Hy Co Sy检查应用广泛,在关注其临床应用价值的同时,也需提高对该检查安全性及相关不良反应的认识,造影前、中、后各期应密切观察患者的状态,警惕晕厥和过敏反应的发生,做好应急处置的临床准备。

Purpose To investigate the adverse reactions and management in the process of transvaginal real-time three-dimensional hysterosalpingo-contrast sonography（3D-Hy Co Sy）. Materials and Methods A total of 976 patients with infertility accepting 3D-Hy Co Sy in Jiangsu Provincial Hospital of Traditional Chinese Medicine, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, from December 2014 to August 2016 were retrospectively analyzed. The pain degree was evaluated using visual analog scale（VAS）. Adverse reactions, including contrast countercurrent, vomiting, syncope and allergies, were recorded. The relationship between adverse reactions and ultrasound imaging signs was explored. Results There were 66 cases（6.76%） of VAS grade 0, 346 cases of mild pain（35.45%）, 374 cases of moderate pain（38.32%） and 190 cases（19.47%） of severe pain. With the increase in the degree of tubal obstruction, the degree of pain gradually increased. Pain was the most common adverse reaction among patients, followed by vomiting（15 cases, 1.54%）,syncope（1 case, 0.10%）, and allergies（1 case, 0.10%）. The incidence of contrast countercurrent was 12.30%（120 cases）. The adverse reaction incidence of patients with abnormal ultrasound imaging signs was significantly higher than that of patients with normal signs（χ^2=29.02, P〈0.01）. Conclusion With the extensive use of 3D-Hy Co Sy examination, its clinical application value has attracted a lot of attention, meanwhile, the understanding of its safety and related adverse reactions should also be improved. The state of patients should be closely observed before, during and after 3D-Hy Co Sy. Medical personnel should watch out for syncope and allergic reactions, and prepare for emergency management.