人工流产术前缩短卡前列甲酯给药时间对软化子宫颈效果和围术期安全性影响随机对照研究
Randomized controlled study on shortening the time of vaginal administration of carboprost methylate supposi-tory before surgical abortion and its effect on cervical ripening and perioperative safety
张多多 1赵毅飞 2申乐 2金力1
作者信息
- 1. 中国医学科学院北京协和医学院北京协和医院国家妇产疾病临床医学研究中心妇产科,北京 100730
- 2. 中国医学科学院北京协和医学院北京协和医院国家妇产疾病临床医学研究中心麻醉科,北京 100730
- 折叠
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.
Abstract
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 preg-nancy 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 sec-ondary 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-re-lated 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 re-duces adverse events.The findings of this study have im-portant clinical implications for improving patients'satis-faction and perioperative safety.
关键词
人工流产术/促子宫颈成熟/围术期安全性/前列腺素/卡前列甲酯Key words
artificial abortion/cervical ripening/perioper-ative safety/prostaglandin/carboprost methylate引用本文复制引用
基金项目
中央高水平医院临床科研专项(2022-PUMCH-A-230)
出版年
2024
国家科技期刊平台
NSTL
万方数据