透视引导上腹下神经丛阻滞缓解子宫动脉栓塞术后疼痛程度的疗效分析

Efficacy of fluoroscopy-guided superior hypogastric nerve block on pain degree after uterine artery embolization

目的探讨上腹下神经丛阻滞(SHNB)缓解子宫动脉栓塞术(UAE)后盆腔痛的临床疗效。方法前瞻性收集2019年2月至2020年12月江苏大学附属镇江第四人民医院50例切口妊娠清宫术前行子宫动脉栓塞术患者,采用随机数字表法将患者随机分为SHNB组(22例)和对照组(28例),SHNB组在UAE前行透视引导SHNB,对照组在栓塞术前肌肉注射地佐辛10 mg,两组病例均在UAE 24 h后行切口妊娠清宫术。采用疼痛数字评分法(NRS)比较两组资料在A1时间段(从UAE开始到术后即刻)和A2时间段(离开介入手术室至清宫术前)的疼痛评分。记录并比较两组资料UAE手术开始至清宫术前阿片类药物的使用剂量。两组之间年龄和体重差异采用独立样本t检验比较,两组之间NRS评分、吗啡剂量的比较采用Mann-Whitney U检验。结果所有患者均顺利完成SHNB和UAE,无严重并发症发生。两组患者年龄、体质量差异无统计学意义(P>0.05)。SHNB组在A1、A2时间段最大疼痛评分分别为0(0,0.25)、2.50(0.75,5.50)分,均低于对照组[3.00(2.00,4.00)、4.00(3.25,7.00)分],差异具有统计学意义(Z值分别为-4.932、-2.351,P值均<0.05)。SHNB组所需吗啡等效剂量[0(0,10.00)mg]低于对照组[10.00(5.00,15.00)mg],差异具有统计学意义(Z=-2.247,P=0.025)。结论透视引导SHNB可明显降低UAE后的疼痛程度和术后阿片类药物的用量,是一种安全、有效、微创的镇痛方法,值得临床推广。

Objective To investigate the clinical efficacy of superior hypogastric nerve block(SHNB)in relieving pelvic pain after uterine artery embolization(UAE).Methods Totally 50 patients of UAE before the curettage of uterine incision pregnancy were selected in Affiliated Zhenjiang Fourth People′s Hospital,Jiangsu University from February 2019 to December 2020 and were randomly divided into SHNB group(n=22)and control group(n=28)using random number table.The SHNB group underwent fluoroscopy-guided SHNB before UAE,and the control group received dizocine 10 mg intramuscularly before embolization.Both groups were treated with curettage 24 h after UAE.The pain scores were evaluated by using a numerical rating scale(NRS)to compare the pain scores between the two groups atthe time period A1(from the beginning of UAE to immediate postoperative period)and at the time period A2(from leaving the interventional operating room to the time before curettage).Data was recorded and compared between the two groups at the time period from the beginning of UAE surgery to the time before curettage for the doses of opioids used.The differences inage and weight between the two groups were compared by independent sample t test,and the NRS score and morphine dose were compared by Mann-whitney U test.Results All patients completed SHNB and UAE without serious complications.There was no significant difference in age and weight between the two groups(P>0.05).The maximum pain scores in the SHNB group were lower than those in the control group at both the A1 and A2 time periods[0(0,0.25)vs.3.00(2.00,4.00),and 2.50(0.75,5.50)vs.4.00(3.25,7.00);Z=-4.932,-2.351,P<0.05].The equivalent dose of morphine required in the SHNB group was lower than that of the control group[0(0,10.00)vs.10.00(5.00,15.00)mg,Z=-2.247,P=0.025].Conclusion Fluoroscopic-guided SHNB is a safe,effective,and minimally invasive way to reduce pain and the opiate dose after UAE.