摘要
目的 探讨四维超声输卵管造影(4D-HyCoSy)过程中疼痛感知的影响因素,以提高患者舒适度和诊断准确性.方法 连续选取2019年7月—2023年7月接受4D-HyCoSy检查病例492例,记录造影结果以及不同时间点和总体的疼痛评分.根据总体疼痛评分将入组病例划分为轻度疼痛组与中度/重度疼痛组,通过Logistic回归探讨4D-HyCoSy检查中发生中度/重度疼痛的独立影响因素,并构建列线图作为预测工具.结果 在两个疼痛组别中,不同时间点出现的疼痛总体上存在差异(x2=37.737,P＜0.001),其中疼痛评分最高均出现在推注对比剂阶段(T4),中位数(P25,P75)分别为1(1,2.75)和6(5,8);冲洗阴道阶段(T1)疼痛程度均为最轻.T4与充盈球囊阶段(T3)和造影后20 min(T5)的疼痛评分均为中度/重度疼痛的独立影响因素(OR分别为2.095、1.308、1.695,P均＜0.05);对共24项临床相关因素进行Logistic回归分析,其中中度和重度痛经、不同程度输卵管堵塞以及对比剂逆流是影响4D-HyCoSy过程中中度/重度疼痛的独立危险因素(P均＜0.05).痛经对检查疼痛的影响:轻度痛经相对于无痛经者,并不增加发生4D-HyCoSy中度/重度疼痛的风险(P=0.225);中度和重度痛经者则是无痛经者的2.603倍及5.657倍.输卵管通畅程度对检查疼痛的影响:不同程度的堵塞相对于双侧通畅者而言,发生中度/重度疼痛的风险均增高,从高至低分别为一侧堵塞一侧通而不畅(OR=4.254)、双侧通而不畅(OR=3.244)、一侧堵塞(OR=2.893)、双侧堵塞(OR=2.823)、一侧通而不畅(OR=2.657).对比剂逆流对检查疼痛的影响:有逆流者更倾向出现中度/重度疼痛(OR=1.959).上述3个因素构建的模型经Hosmer-Lemeshow检验表明,该模型拟合良好(P=0.880),校准曲线接近理想曲线.结论 在进行4D-HyCoSy过程中,需注意在T3、T4、T5三个阶段给予患者更细致的疼痛管理措施,同时需对于中重度痛经、不同程度的输卵管堵塞及出现对比剂逆流的患者制定针对性的个体化疼痛管理策略,以提高其体验和诊断准确率.
Abstract
Objective To investigate the factors influencing pain perception during four-dimensional hysterosalpingo-contrast sonography(4D-HyCoSy)to improve patient comfort and enhance clinical diagnostic accuracy.Methods In this retrospective study,492 consecutive patients who underwent 4D-HyCoSy from July 2019 to July 2023 were included.Comprehensive clinical data,imaging outcomes,and pain scores across various procedural stages were collected.Based on their overall pain scores,patients were classified into mild and moderate/severe pain categories.Logistic regression analysis was performed to investigate the independent factors influencing the occurrence of moderate/severe pain during 4D-HyCoSy examinations and a nomogram was developed as a predictive tool.Results In both groups,significant differences were observed in pain levels across various time points(x2=37.737,P＜0.001).The highest median pain scores of 1(1,2.75)were recorded during the contrast agent injection phase(T4)in mild pain group and 6(5,8)in moderate/severe pain group.The vaginal washing phase(T1)consistently showed the lowest pain intensity.Pain scores from T4,balloon inflation stage(T3)and 20 minutes post-contrast(T5)were identified as independent predictors of moderate/severe pain(OR=2.095,1.308,and 1.695,respectively;all P＜0.05).A logistic regression analysis involving 24 clinical factors highlighted moderate and severe dysmenorrhea,varying degrees of fallopian tube blockage,and contrast medium reflux as significant independent risk factors for moderate/severe pain during the procedure(all P＜0.05).Mild dysmenorrhea did not increase(OR=2.603)whereas moderate to severe dysmenorrhea significantly increased(OR=5.657)the risk of moderate/severe pain.Fallopian tube blockage severity also influenced pain levels,with unilateral blockage and contralateral poor patency presenting the highest risk(OR=4.254),followed by bilateral poor patency(OR=3.244),unilateral blockage(OR=2.893),bilateral blockage(OR=2.823),and unilateral poor patency(OR=2.657).Women with contrast medium reflux were more likely to experience moderate/severe pain(OR=1.959).The nomogram constructed from the three aforementioned factors as assessed by the Hosmer-Lemeshow test,demonstrates a good model fit(P=0.880)with the calibration curve closely resembling the ideal curve.Conclusion The findings underscore the importance of meticulous pain management during 4D-HyCoSy,particularly at critical stages T3,T4,and T5.Tailored pain management strategies,especially for patients with moderate to severe dysmenorrhea,different levels of fallopian tube blockage,and those experiencing contrast medium reflux,are imperative to mitigate patient discomfort and improve diagnostic accuracy.
基金项目
深圳市科技计划项目(JCYJ20190814170205768)
NETL
NSTL
万方数据