可视人流仪术中监测对瘢痕子宫取环妇女应激状态的影响-东南大学学报医学版

可视人流仪术中监测对瘢痕子宫取环妇女应激状态的影响

单位：1. 江苏大学医学院, 江苏镇江 212013;
2. 无锡市锡山人民医院/东南大学附属中大医院无锡分院妇产科, 江苏无锡 214011

分类号：R714

出版年·卷·期（页码）：2017·36·第二期（261-265）

摘要：

目的：研究可视人流仪术中监测对瘢痕子宫妇女取环术中的应激激素的影响及临床疗效。方法：按随机数字表法将拟行取环术再生育的瘢痕子宫妇女分为A、B两组，A组实验组采用可视人流仪监护下取环，B组对照组采用常规方法取环，比较两组取环手术的手术时间、术中出血量、术中疼痛程度、手术顺利情况、应激激素变化、术后第一次月经来潮时间及月经变化、术后妊娠等情况。结果：A组与B组相比，术中疼痛程度轻、一次性手术取环成功率高（98.95% vs 90%）、子宫穿孔发生例数少（0 vs 5例），术后阴道流血时间短（6.5±12.03 vs 10.34±10.34天），术后第一次月经来潮快（25.12±0.56 vs 30.45±1.87天），宫颈管粘连的发生病例数少（2 vs 8例）。B组术前和术中、术后的应激激素血液表达水平均高于A组，且两组术中血液表达水平均高于术前及术后，差异均具有统计学意义（P<0.05）。术后三月妊娠率高（11.45% vs 3.0%）差异有统计学意义（P<0.05）.而术后一年妊娠率（36.45% vs 33%），差异无统计学意义（P>0.05）。结论：可视人流仪对瘢痕子宫取环术中监护对患者应激状态影响小，要好于常规方法，安全性更高。

Objective: To study the effect of visual artificial abortion monitor on stress hormones and clinical curative effect of operation during the removal of intrauterine device from scarred uterus.Methods: Patients with scarred uterus scheduled for reproduction after removal of intrauterine device were randomly divided into two groups in accordance with the random number table. The experiment group was subjected to extraction of intrauterine device under the monitoring of visual artificial abortion monitor while the control group was operated by conventional method. The operation time, the amount of bleeding, adverse effect,the intraoperative pain degree, success rate of surgery, the level of stress hormones of two groups before the examination, during the examination and after the examination, postoperative vaginal bleeding, first postoperative menstruation and cycle, and pregnancy after operation were detected and compared. Results: Group A compared with group B, a significant decrease was observed in the operation time(from 4.2±0.30 to 2.2±0.66 min), the amount of intraoperative bleeding (from 5.4±1.4 to 2.8±1.6 ml), and in intraoperative pain degree, success rate of surgery was higher,the leveI of stress hormones and pain stress indexes of group B before the operation, during the operation and after the operation were all significantly higher than those of group A,and the levels of two groups during the operation were all significantly higher than those before the operation and after the operation; first postoperative menstruation was shorter(from25.12±0.56 to 30.45±1.87 days), and occurance of the cervix of the uterus tube adhesion was lower(from 2 to 8 cases); the pregnancy rate of three month after operation was higher(from 11.45% to 3.0% )(P<0.05). A significant increase was not observed in the pregnancy rate of one year after operation(from 36.4% to 33% )(P>0.05). Conclusion: The visual abortion monitor has little effect on stress state of patients with scarred uterus than the conventional method,and has higher safety.

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