硬膜外镇痛泵与静脉镇痛泵在子宫动脉栓塞治疗子宫肌瘤时镇痛效果和安全性的对比研究

Analgesic effect and safety of using an epidural analgesia pump versus an intravenous analgesia pump for uterine artery embolization in the treatment of uterine fibroids

目的比较硬膜外镇痛泵与静脉镇痛泵在子宫动脉栓塞治疗子宫肌瘤时的镇痛效果及安全性。方法选取温州医科大学附属第二医院育英儿童医院2019年1月至2021年12月收治的行子宫动脉栓塞术的子宫肌瘤患者50例作为观察对象,采用随机数字表法分为观察组和对照组各25例。观察组使用硬膜外镇痛泵镇痛,对照组使用静脉镇痛泵镇痛。在术后1 h、6 h、12 h、24 h,采用疼痛视觉模拟(visual analogue scale,VAS)评分比较两组疼痛程度,采用舒适评分量表(bruggrmann comfort scale,BCS)评分比较两组舒适程度,并比较两组患者手术前后的呼吸、心率、血压及术后不良反应发生情况。结果术后1 h,观察组VAS评分[3.00(2.00,5.50)]低于对照组[7.00(6.00,8.00)](Z=-3.84,P<0.05);术后6 h、12 h、24 h,两组VAS评分差异均无统计学意义(均P>0.05)。术后24 h内,观察组使用的阿片类镇痛药物[16.00%(4/25)]少于对照组[88.00%(22/25)](χ^(2)=25.96,P<0.001)。术后1 h,观察组BCS评分[0.00(0.00,0.50)]高于对照组[0.00(0.00,0.00)](Z=2.08,P<0.05);术后6 h、12 h、24 h,两组BCS评分差异均无统计学意义(均P>0.05)。两组术后心率均较术前明显下降(均P<0.05)。两组手术前后的呼吸频率、平均动脉压差异均无统计学意义(均P>0.05)。两组术后恶心呕吐、发热的发生率差异均无统计学意义(均P>0.05)。结论子宫动脉栓塞治疗子宫肌瘤时使用硬膜外镇痛泵比静脉镇痛泵具有更好的镇痛效果、舒适程度及安全性,值得临床推广。

Objective To investigate the analgesic effect and safety of using an epidural analgesia pump versus an intravenous analgesia pump for uterine artery embolization in the treatment of uterine fibroids.Methods Fifty patients with uterine fibroids undergoing uterine artery embolization admitted to The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from January 2019 to December 2021 were included in this study.They were divided into an observation group and a control group(n=25/group).Patients in the observation group used an epidural analgesia pump for pain relief,while patients in the control group used an intravenous analgesia pump for pain relief.At 1,6,12,and 24 hours after surgery,pain severity was compared between the two groups using the Visual Analogue Scale.Comfort level was compared between the two groups using the Bruggemann Comfort scale.Before and after surgery,respiratory rate,heart rate,blood pressure,and adverse reactions were compared between the two groups.Results At 1 hour after surgery,the Visual Analogue Scale score in the observation group was significantly lower than that in the control group[3.00(2.00,5.50)vs.7.00(6.00,8.00),Z=-3.84,P<0.05].At 6,12,and 24 hours after surgery,there was a significant difference in the Visual Analogue Scale score between the two groups(all P>0.05).Within 24 hours after surgery,the use of opioid analgesics in the observation group was less than that in the control group[16.00%(4/25)vs.88.00%(22/25),χ^(2)=25.96,P<0.001].At 1 hour after surgery,the Bruggemann Comfort Scale score in the observation group was significantly higher than that in the control group[0.00(0.00,0.50)vs.0.00(0.00,0.00),Z=2.08,P<0.05].At 6,12,and 24 hours after surgery,there was no significant difference in the Bruggemann Comfort Scale score between the two groups(all P>0.05).After surgery,heart rate was significantly decreased in each group compared with before surgery(both P<0.05).There were no significant differences in respiratory rate and mean arterial pressure between the two groups before and after surgery(both P>0.05).There were no significant differences in the incidences of postoperative nausea,vomiting,and fever between the two groups(all P>0.05).Conclusion The epidural analgesia pump used for uterine artery embolization in the treatment of uterine fibroids has a better analgesic effect and provides more comfort and is safer than the intravenous analgesia pump.The former is worthy of clinical promotion.