双氯芬酸钠栓在门诊无创宫腔镜检查中应用研究

Clinical application of rectal diclofenac sodium suppositories in non-invasive outpatient hysteroscopy

目的探讨直肠给予双氯芬酸钠栓与阴道给予米索前列醇在门诊无创宫腔镜检查中减少患者疼痛的差异。方法回顾性分析广州市妇女儿童医疗中心2016年4月至2016年12月在门诊行无创宫腔镜检查患者196例。患者分成3组。其中A组63例,术前未给予任何药物处置;B组51例,均术前2 h接受阴道给药米索前列醇200μg;C组82例,术前60 min直肠给予双氯芬酸钠栓100 mg。记录患者疼痛程度,按从0分(无痛)到10分(剧痛)可视量化评分,比较宫腔镜检查时间、术中不良反应、术后镇痛的需求及心脑综合征(PASS)发生情况。结果宫腔镜检查时间A组(7.61±2.23)min,B组(7.04±2.95)min,C组(6.12±1.72)min,3组差异无统计学意义;术中C组发生PASS和不良反应0例,明显低于B组,差异有统计学意义(P<0.05);术中C组发生中重度疼痛7例(8.75%),分别与A组和B组比较,差异均有统计学意义(P<0.05)。结论门诊无创宫腔镜检查术前应用双氯芬酸钠栓具有疼痛轻、无需麻醉、不良反应发生率低、效果好等优点。

Objective To assess whether rectal administration of diclofenac sodium suppositories or vaginal administration of misoprostol reduces pain during non-invasive outpatient hysteroscopy. Methods Totally 196 outpatients were given diagnostic hysteroscopy from April to December in 2016 in Guangzhou Women and Children＇s Medical Center.They were divided into three groups. A total of 63 patients in group A were not given any drug treatment before the procedure. A total of 51 patients in group B received 200 ug misoprostol vaginally 2 hours before the procedure. A total of 82 patients in group C received 100 mg Diclofenac sodium suppository rectally 60 minutes before the procedure. Patients were asked to record the severity of pain,using a visual analog scale ranging from 0（painless）to 10（very painful）. Comparie hysteroscopy time,intraoperative adverse reactions,postoperative analgesic demand and the occurrence of heart and brain syndrome（PASS）.Results There were no significant differences in procedural time among the three groups（7.61 ± 2.23 min in group A,7.04± 2.95 min in group B,6.12 ± 1.72 min in group C）. In group C,there were no PASS cases and no adverse reaction happened,which were significantly less than group B. Seven cases showed severe pain（8.75%）in group C,which had significant differences compared to the group A and group B.Conclusion Preoperative administration of diclofenac sodium suppositories has the advantages of less pain,no anesthesia,low incidence of adverse reactions and good effect.