摘要
目的 探索缩短卡前列甲酯(卡孕栓)在全麻人工流产术(人流)术前的给药时间对软化子宫颈的效果和围术期安全性的影响。方法 前瞻性纳入北京协和医院2022年11月至2023年2月行人流负压吸引的早孕期患者120例,术前使用卡孕栓软化子宫颈。随机分为两组:A组在术前1.5~2.0h给药;B组在麻醉前给药。两组平均用药时间分别为(111.9±23.4)min和(21.5±10.6)min。研究初级结局指标为子宫颈扩张时间;次级结局指标为手术完成指标,包括手术时间、总出血量和7.5号扩宫棒初次通过率,以及围术期不良反应,包括发热、腹痛、恶心、呕吐及便意和腹泻等。结果 两组患者在扩宫时间和手术完成指标上差异均无统计学意义,但在麻醉前A组出现的总不良反应率显著高于B组(93.4%vs. 28.8%,P<0.01),其中A组腹痛分数高于B组[(2.8±2.1)分vs.(0.3±0.5)分,P<0.01]。A组术后恶心、呕吐的发生率也显著高于B组(18.3%vs. 6.7%,P=0.04)。结论 阴道内放置卡孕栓时间延迟至麻醉前仍然能够充分软化人流手术患者的子宫颈,并减少药物相关不良反应,有助于改善患者就医体验和保障围术期安全。
Objective To investigate whether shortening the time of vaginal administration of carboprost methylate(CM)suppository has effect on perioperative safety and cervical ripening in surgical abortion under general anesthesia.Methods This prospective clinical study included 120 patients undergoing surgical termination of first trimester pregnancy and using CM for cervical preparation from November 2022 to Feberary 2023.Group A received CM at 1.5~2.0h before surgery;group B were given CM just before anesthesia.The average time of medication in both groups was(111.9±23.4)min and(21.5±10.6)min,respectively.The primary outcome was the cervical dilation time,and the secondary outcomes included surgery completeness(surgery time,total bleeding and percentage of initial-passing 7.5 Hegar dilator),and perioperative adverse events(fever,abdominal pain,vomiting,nausea,desire to defecate,diarrhea).Results The dilation time of cervix and surgery completeness were similar between the two groups.However,CM-related adverse events before anesthesia were significantly higher in group A than in group B(93.4%vs.28.8%,P<0.01),and the abdominal pain numerical rating scale(NRS)score was higher in group A[(2.8±2.1)vs.(0.3±0.5),P<0.01].The incidence of postoperative vomiting and nausea(PONV)was also significantly higher in group A(18.3%vs.6.7%,P=0.04).Conclusions Delayed vaginal administration of CM until before anesthesia is effective enough for cervical priming in surgical abortion and significantly reduces adverse events.The findings of this study have important clinical implications for improving patients'satisfaction and perioperative safety.
作者
张多多
赵毅飞
申乐
金力
ZHANGDuo-duo;ZHAO Yi-fei;SHEN Le;JIN Li(Department of Obstetrics and Gynecology,National Clinical Research Center for Obstriccs&Gynecologic Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;不详)
出处
《中国实用妇科与产科杂志》
CAS
CSCD
北大核心
2024年第3期349-353,共5页
Chinese Journal of Practical Gynecology and Obstetrics
基金
中央高水平医院临床科研专项项目(2022-PUMCH-A-230)。
