不同镇痛药物在经阴道穿刺取卵术中的应用效果

Effect of different analgesics in transvaginal puncture for oocyte extraction

目的评价经阴道取卵术中常用镇痛药物的有效性和安全性,为经阴道穿刺取卵术中镇痛药物的合理选择提供参考和借鉴。方法选择医院生殖中心2018年8月—2019年1月进行经阴道穿刺取卵术的患者410例,分为不用镇痛药物(69例)、采用双氯芬酸钠栓100 mg(101例)、盐酸曲马多注射液100 mg(140例)、盐酸哌替啶注射液50 mg(100例)。观察上述4组患者经阴道穿刺取卵中的镇痛效果及术后不良反应,采用长海痛尺评分评估术后镇痛效果。结果4组患者疼痛控制效果理想率(含无痛和轻度疼痛)分别为86.96%、82.18%、65.00%和65.00%。将长海痛尺评分控制在2分及以下为控制效果理想,>2分为控制欠佳。统计分析结果显示,夜针日卵泡数越少、无痛经、取卵过程中不穿子宫的患者疼痛控制效果理想,控制其他因素后4组药物的取卵疼痛控制效果差别无统计学意义。4组患者中盐酸哌替啶注射液发生不良反应(恶心、呕吐、头晕、大汗)的平均数量最多,且夜针日卵泡数较多者和采用盐酸哌替啶注射液的患者更易发生不良反应,盐酸哌替啶注射液的不良反应发生风险为盐酸曲马多注射液的9.71倍。结论经阴道穿刺取卵术中应用双氯芬酸钠栓或盐酸曲马多注射液可产生良好的镇痛效果,且不良反应少,使用方便,值得临床应用推广。

Objective To evaluate the efficacy and safety of commonly used analgesic drugs in transvaginal puncture for oocyte extraction,and to provide reference for rational selection of analgesic drugs.Methods 410 patients who under-went transvaginal puncture for oocyte retrieval from the reproductive center of Changhai Hospital from August 2018 to January 2019 were selected.They were divided into no analgesic drugs(69 cases),diclofenac sodium suppository 100mg(101 cases),tramadol hydrochloride injection 100mg(140 cases),and pethidine hydrochloride injection 50mg(100 cases).The analgesic effects and postoperative adverse reactions in the above four groups of patients were observed and the postoperative analgesia effect was evaluated using the long-term pain scale.Results The ideal rate of pain control effect(including painless and mild pain)was 86.96%,82.18%,65.00%and 65.00%respectively.If the score of Changhai pain scale was controlled at 2 or below,the control effect was ideal.If the score was greater than 2,the control effect was poor.Logistic regression was used to analyze the pain control effects and related factors of the four groups.The results showed that the pain control effects were ideal in patients with fewer follicles at night per day,no dysmenia,and no uterine puncture in the process of oocyte retrieval.After controlling for other factors,there was no statistically significant difference in the pain control effects in the four groups.The average number of adverse reactions(nausea,vomiting,dizziness,and sweating)caused by pethidine hydrochloride injection was the largest in the four groups.Adverse reactions were more likely to occur in patients with higher number of follicles at night and in patients with pethidine hydrochloride injection,and the risk of adverse reactions in pethidine hydrochloride injection was 9.71 times that of tramadol hydrochloride injection.Conclusion The application of diclofenac sodium suppositure or tramadol hydrochloride injection in transvaginal puncture for oocyte extraction has a relatively good analgesic effect,less adverse reactions and convenient to use.