在妊娠9周以下的药物流产期间与严重疼痛相关的因素:多中心,随机,安慰剂控制试验的二次分析
Kelsey B Loeliger1, Monica V Dragoman2, Nathalie Kapp3
1Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, United States.
Contraception
|March 1, 2025
概括
药物流产期间的严重疼痛与疼痛管理之外的因素有关,包括分娩史和经期障碍. 了解这些预测因素可以改善患者的咨询和堕胎方法的决策.
科学领域:
- 产科和妇科 产科和妇科
- 药理学 药理学是指药理学的学科.
- 公共卫生 公共卫生
背景情况:
- 药物流产是早期终止怀孕的常见程序.
- 疼痛管理是药物流产经验的关键方面.
- 识别与严重疼痛相关的因素可以优化患者的护理和咨询.
研究的目的:
- 为了确定除了疼痛管理之外的因素,在妊娠9周之前的药物流产期间与严重疼痛相关.
- 为患者咨询提供信息,并改善关于堕胎方法的决策.
主要方法:
- 在越南,尼泊尔和南非进行的一项随机试验的二次分析.
- 用多变量逻辑回归分析了556名参与者的数据.
- 研究的因素与严重的疼痛相关 (得分≥8/10) 在8小时内misoprostol的管理.
主要成果:
- 近一半 (49.1%) 的参与者经历了严重的疼痛.
- 多种性与严重疼痛的几率降低有关 (OR 0.35).
- 淋病 (OR 1.16) 和更长的妊娠期 (OR 1.05) 与严重疼痛的几率增加有关.
- 在多胎患者中,剖腹产史 (OR 3.49) 和分娩期间的严重疼痛 (OR 2.36) 与严重疼痛有显著联系.
- 社会人口统计学因素,包括焦虑和抑郁症,与严重的疼痛无关.
结论:
- 药物流产期间的严重疼痛与多夫妇,经期障碍,妊娠持续时间,剖腹产史和分娩时的严重疼痛有关.
- 没有发现焦虑和抑郁与严重疼痛有关.
- 研究结果可以为堕胎前咨询提供信息,使患者能够做出更明智的选择,并为疼痛管理做好准备.
相关概念视频
Opioid Analgesics: Synthetic and Semisynthetic Opioids
204
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
204
Appendicitis-I: Introduction
76
The appendix, a small, narrow, blind tube extending from the inferior part of the cecum, is widely regarded as a vestigial organ, having lost much of its original function through evolution. Despite its diminished role, the appendix can become inflamed, a condition known as appendicitis.
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...
76
Analgesia and Pain Management
422
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
422
Local Anesthetics: Clinical Application as Epidural Anesthesia
406
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
406
Local Anesthetics: Differential Sensitivity of Nerve Fibers
749
Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...
749
Parenteral Anesthetics: Overview
92
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
92


