庄小兰　白群　邹永红等

[摘要] 目的 探讨米索前列醇联合阿托品、双氯芬酸钠栓在门诊未产妇宫腔镜手术中的临床效果。 方法 选取2011年5月～2014年5月本院门诊的100例宫腔镜手术患者作为研究对象，随机分为观察组和对照组，各50例。观察组术前12 h阴道后穹隆放置米索前列醇，术前1 h肌内注射阿托品并予双氯芬酸钠塞肛。对照组仅放置米索前列醇，比较两组的效果。 结果 两组的宫颈软化程度比较，差异无统计学意义（P>0.05）。观察组的镇痛效果显著优于对照组，差异有统计学意义（P<0.05）。观察组的扩宫时间显著短于对照组，术中出血量显著少于对照组，人工流产综合征发生率显著低于对照组，差异有统计学意义（P<0.05）。 结论 在门诊未产妇宫腔镜手术前应用米索前列醇联合阿托品、双氯芬酸钠栓对于宫颈扩张及镇痛均有较好疗效，且副作用低，值得临床推广应用。 [关键词] 米索前列醇；阿托品；双氯芬酸钠；宫腔镜手术

[中图分类号] R713.1 [文献标识码] A [文章编号] 1674-4721（2015）09（a）-0105-03

[Abstract] Objective To explore the clinical effect of misoprostol combined with atropine and diclofenac sodium in outpatient hysteroscopic surgery on nulliparae. Methods 100 nulliparae given outpatient hysteroscopic surgery were selected and randomly divided into the observation group and the control group，50 patients in each group.The observation group was given misoprostol placed in the vaginal posterior fornix before surgery at 12 hours，and atropine injected intramuscularly and diclofenac sodium was plugged in anus before surgery at 1 hour.The control group was only given misoprostol placed in the vaginal posterior fornix.The effect of two groups was compared. Results There was no significant difference in the softening cervix degree between two groups（P>0.05）.The analgesic effect of the observation group was better than that of the control group，with significant difference （P<0.05）.The time of cervix expansion in the observation group was shorten than that in the control group，the amount of blood loss during operation in the observation group was less than that in the control group，the incidence rate of artificial abortion syndrome was lower than that in the control group，with significant difference （P<0.05）. Conclusion The application of misoprostol combined with atropine and diclofenac sodium before the implementation of outpatient hysteroscopic surgery on nulliparae shows good efficacy on cervix expansion and analgesia，and causes low side effect，it is worthy of clinical promotion and application.

[Key words] Misoprostol；Atropine；Diclofenac sodium；Hysteroscopy

宫腔镜手术是一种经人体自然腔道的手术方式，具有微创、手术时间短、恢复快等优点，随着宫腔镜手术的逐渐普及及发展，其已经与传统开腹手术、经阴道手术、腹腔镜手术一起成为妇科手术的四大手术基本技能。宫腔镜手术分为门诊宫腔镜手术及住院宫腔镜手术，门诊宫腔镜手术基本能够完成较多简单、历时短的手术操作，如宫腔镜检查、子宫息肉摘除、宫腔内病变活检、宫腔内异物摘除、节育器取出、子宫黏膜下小肌瘤电切术等。

门诊宫腔镜手术可在静脉麻醉或不麻醉下进行，因术前静脉麻醉可能引起相关副作用及并发症，如抑制呼吸及循环系统、麻醉药物变态反应、术中出血偏多、部分患者苏醒困难、治疗费用增加等，故限制了静脉麻醉的应用范围。由于手术历时短、且绝大多数患者能耐受门诊宫腔镜手术，再加上部分患者害怕……