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  • 王瑞,王金萍*,陈晓艺.实时三维子宫输卵管超声造影检查过程中发生中重度疼痛的影响因素[J].第二军医大学学报,2019,40(8):923-928    [点击复制]
  • WANG Rui,WANG Jin-ping*,CHEN Xiao-yi.Influencing factors of moderate-to-severe pain in real-time three-dimensional hysterosalpingo-contrast sonography[J].Acad J Sec Mil Med Univ,2019,40(8):923-928   [点击复制]
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实时三维子宫输卵管超声造影检查过程中发生中重度疼痛的影响因素
王瑞,王金萍*,陈晓艺
0
(安徽中医药大学第一附属医院超声科, 合肥 230031
*通信作者)
摘要:
目的 分析经阴道实时三维子宫输卵管超声造影(RT-3D-HyCoSy)检查过程中重度疼痛的影响因素。方法 选择2017年1月至2018年12月在安徽中医药大学第一附属医院超声科行RT-3D-HyCoSy检查的疑诊不孕症患者235例。采用数字评价量表(NRS)评估疼痛程度,并将患者分为非中重度疼痛组(NRS评分为0~3分)和中重度疼痛组(NRS评分为4~10分)。比较两组患者的年龄、不孕时间、不孕类型、输卵管通畅程度、造影球囊大小、造影剂逆流、宫腔占位、子宫畸形、宫腔粘连带、子宫位置、宫外孕史、妇科炎症、盆腔手术史及情绪状态。采用logistic回归模型进行多因素分析,探寻RT-3D-HyCoSy检查过程中发生中重度疼痛的危险因素,并绘制受试者工作特征(ROC)曲线评价各因素的预测价值。结果 单因素分析结果显示球囊大小(≥ 2 mL)、造影剂逆流、输卵管通畅异常、宫腔粘连带、情绪紧张焦虑是RT-3D-HyCoSy检查过程中发生中重度疼痛的影响因素(P<0.01,P<0.05)。多因素分析结果显示球囊大小(≥ 2 mL)、输卵管通畅异常、情绪紧张焦虑是中重度疼痛的危险因素[比值比(OR)=2.223,95%置信区间(CI):1.088~4.542,P<0.05;OR=13.824,95% CI:5.582~34.239,P<0.01;OR=2.606,95% CI:1.255~5.414,P<0.05)。ROC曲线证实球囊大小(≥ 2 mL)、输卵管通畅异常、情绪紧张焦虑三者联合对RT-3D-HyCoSy检查过程中发生中重度疼痛的预测价值最高(曲线下面积为0.841,95% CI:0.785~0.898)。结论 球囊大小(≥ 2 mL)、输卵管通畅异常和情绪紧张焦虑是RT-3D-HyCoSy检查中产生中重度疼痛的危险因素。在RT-3D-HyCoSy检查过程中应重视中重度疼痛产生的诱因并尽可能规避,以提高患者检查的舒适度和检查的成功率。
关键词:  疼痛  实时三维子宫输卵管超声造影  危险因素  不孕症
DOI:10.16781/j.0258-879x.2019.08.0923
投稿时间:2019-04-27修订日期:2019-06-26
基金项目:安徽省2018年度重点研究与开放计划(1804h08020248).
Influencing factors of moderate-to-severe pain in real-time three-dimensional hysterosalpingo-contrast sonography
WANG Rui,WANG Jin-ping*,CHEN Xiao-yi
(Department of Ultrasound, First Affiliated Hospital, Anhui University of Chinese Medicine, Hefei 230031, Anhui, China
*Corresponding author)
Abstract:
Objective To explore the influencing factors of moderate-to-severe pain in transvaginal real-time three-dimensional hysterosalpingo-contrast sonography (RT-3D-HyCoSy). Methods Totally 235 suspected infertility patients who underwent RT-3D-HyCoSy in the First Affiliated Hospital of Anhui University of Chinese Medicine between Jan. 2017 and Dec. 2018 were chosen for this study. The degree of pain was assessed by numeric rating scale (NRS). The patients were divided into non-moderate-to-severe pain group (NRS score was 0-3) and moderate-to-severe pain group (NRS score was 4-10). Patients' age, infertile time, infertile type, fallopian tube patency, balloon size (≥ 2 mL), contrast agent reflux, uterine space-occupying lesion, uterine malformation, intrauterine adhesion, uterine position, ectopic pregnancy history, gynecological inflammation, pelvic surgery history and emotion were collected for comparison between the two groups. Multivariate logistic regression model was used to analyze the risk factors of moderate-to-severe pain during RT-3D-HyCoSy examination, and receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of each factor. Results The univariate analysis showed that the balloon size (≥ 2 mL), contrast agent reflux, abnormal fallopian tube patency, intrauterine adhesion, and emotional tension were the influencing factors for moderate-to-severe pain (P<0.01, P<0.05). The multivariate logistic regression model showed that balloon size (≥ 2 mL), abnormal fallopian tube patency, and emotional tension were the risk factors for moderate-to-severe pain (odds ratio[OR]=2.223, 95% CI:1.088-4.542, P<0.05; OR=13.824, 95% CI:5.582-34.239, P<0.01:OR=2.606, 95% CI:1.255-5.414, P<0.05). ROC curve confirmed that multi-factor (balloon size ≥ 2 mL, abnormal fallopian tube patency, and emotional tension) combined had the highest prediction accuracy for moderate-to-severe pain (area under curve[AUC]=0.841, 95% CI:0.785-0.898). Conclusion Balloon size (≥ 2 mL), abnormal fallopian tubal patency and emotional tension are risk factors for moderate-to-severe pain in RT-3D-HyCoSy examination. During RT-3D-HyCoSy examination, we should pay attention to the causes of moderate-to-severe pain and avoid them, so as to improve the comfort level of patients and the success rate of the examination.
Key words:  pain  real-time three-dimensional hysterosalpingo-contrast sonography  risk factors  infertility