【摘要】：目的:前瞻性地分析子宮輸卵管造影術相關疼痛的影響因素,觀察耳穴壓丸運用于子宮輸卵管造影術的止痛效果,以指導臨床研究。方法:采用隨機對照的實驗方法,將符合納入標準的研究對象180名,隨機分為耳穴組91名,安慰組89名。耳穴組采用王不留行籽貼壓雙側神門、皮質下、內(nèi)分泌、子宮等穴位,并囑患者造影術前15min以拇指、食指對壓耳穴,每個穴位以60-80次/min的頻率進行按壓,每五分鐘按壓一次,每次持續(xù)1分鐘,雙側交替,術后以同樣方式按壓15min。安慰組在上述耳穴位置敷貼外形、數(shù)量相同的膠布,不予任何刺激。術前醫(yī)生填寫調查表,記錄患者不孕類型、既往分娩方式、學歷背景、痛經(jīng)史、手術史等資料。術后患者自評分,分別記錄子宮輸卵管造影術器械操作、對比劑注入、術后30分鐘時的VAS評分。分析子宮輸卵管造影相關疼痛影響因素,觀察比較三個不同操作時期VAS評分差異,并比較耳穴組與安慰組VAS評分、術后不良反應率的差異。結果:(1)子宮輸卵管造影相關疼痛特點:對比劑注入時VAS評分最高,器械操作時次之,術后30min最低,組間比較差異顯著,且有統(tǒng)計學意義(P值均小于0.01)。(2)子宮輸卵管造影相關疼痛影響因素:對比劑注入時,繼發(fā)不孕患者VAS評分顯著低于原發(fā)不孕患者,差異有統(tǒng)計學意義(P0.01);順產(chǎn)患者VAS評分低于剖腹產(chǎn)、流產(chǎn)、宮外孕患者,差異有統(tǒng)計學意義(P0.05)。HSG造影結果異�；颊咴谛g后30min時VAS評分高于造影結果正�；颊�,差異有統(tǒng)計學意義(P0.05)。學歷背景、痛經(jīng)史、腹盆部手術或感染史等比較差異無統(tǒng)計學意義(P0.05)。(3)耳穴壓丸組止痛療效觀察:子宮輸卵管造影三個不同操作時期,耳穴組VAS評分均低于安慰組,差異有統(tǒng)計學意義(P0.05)。結論:子宮輸卵管造影相關疼痛在對比劑注入時程度最劇烈;既往分娩方式、不孕類型、HSG造影結果是HSG相關疼痛影響因素;耳穴壓丸法可在一定程度上緩解HSG相關疼痛,并降低術后不良反應率。
[Abstract]:Objective: to prospectively analyze the factors influencing the pain associated with hysterosalpingography and to observe the analgesic effect of auricular acupoint compression pill in hysterosalpingography in order to guide the clinical study. Methods: 180 subjects were randomly divided into auricular point group (n = 91) and comfort group (n = 89). The auricular acupoints group were pressed by Wang Buliu seed sticking, pressing bilateral acupoints such as Shenmen, subcortex, endocrine, uterus and so on. The patients were told to press the auricular points with thumb and index finger before contrast radiography with 60 to 80 times per min per acupoint. Press once every five minutes, 1 minute each time, alternately bilateral, press 15 minutes in the same way after operation. Comfort group in the above-mentioned auricular point application shape, the same amount of tape, no stimulation. Before operation, doctors filled out questionnaires to record the type of infertility, previous delivery style, educational background, dysmenorrhea history, surgical history and so on. The operation of hysterosalpingography instruments, injection of contrast media, and VAS score 30 minutes after operation were recorded. To analyze the influencing factors of hysterosalpingography related pain, to observe and compare the difference of VAS score in three different operation periods, and to compare the difference of VAS score between auricular acupoint group and comfort group, and the rate of adverse reaction after operation. Results: (1) the characteristics of hysterosalpingography related pain: the VAS score was the highest when the contrast agent was injected, the second was when the instrument was operated, the 30min was the lowest after operation, and the difference between the groups was significant. There were statistically significant (P < 0. 01). (2) factors affecting the pain associated with hysterosalpingography: the VAS score of the infertile patients with secondary infertility was significantly lower than that of the patients with primary infertility when the contrast agent was injected. The difference was statistically significant (P0.01). The VAS score of patients with spontaneous delivery was lower than that of patients with cesarean section, abortion and ectopic pregnancy, the difference was statistically significant (P0.05) the VAS score of patients with abnormal). HSG results was higher than that of patients with normal 30min results after operation. The difference was statistically significant (P0.05). Educational background, history of dysmenorrhea, history of abdominal and pelvic surgery or infection were not significantly different (P0.05). (3) observation of analgesic effect in auricular acupoint pressing pill group: hysterosalpingography was performed in three different stages. The VAS score of auricular acupoint group was lower than that of comfort group, the difference was statistically significant (P0.05). Conclusion: hysterosalpingography associated pain is the most severe in contrast medium injection, previous delivery mode, type of infertility, and HSG findings are the influencing factors of HSG related pain. Auricular acupoint pressing pill can relieve HSG-related pain to some extent and reduce the rate of postoperative adverse reactions.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R711.6;R816.91

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