0 Introduction
?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
Induced abortion is a remedy for contraceptive failure. Many complications of traditional artificial abortion, including intraoperative pain, incomplete uterine aspiration and even bleeding, uterine perforation, intraoperative pain is the main reason of fear is not willing to accept patients with artificial abortion. The use of nitrous oxide and propofol used in painless abortion of early pregnancy, can reduce the pain of patients, but increase the risk of uterine trauma and anesthesia accident.
????????????????????????????????????????????????????????????????????????????????????????????
In order to reduce the abortion of uterine trauma and surgical complications, our department carried out the artificial abortion pregnancy without negative pressure, to obtain better results. In order to further improve the clinical application of this operation. The non negative pressure for rotating clinical study of artificial abortion, report as follows now.
1 ?????
1 data and methods
1.1 ?????? 2015 ? 2 ?? 2016 ? 1 ????????????? 40~55 ??B ???????????? 1.0~4.0cm,?????????????????? 600 ?????????????????????? 300 ?????????????????????????????? 45 ?????18 ???? 28.1 ??
1.1 objects. Collected from February 2015 to January 2016 in our hospital, menopause 40~55 days, B ultrasound examination confirmed the intrauterine gestational sac diameter 1.0~4.0cm, and the voluntary termination of pregnancy induced abortion in early pregnancy women, a total of 600 cases. Is the negative pressure group and traditional painless artificial abortion group, 300 cases in each. To inform the risk of induced abortion before operation and to sign the informed consent form. The two group was the oldest 45 years old, the youngest was 18 years old, and the average age was 28.1 years.
1.2 ???????? 35~60 ??? HCG ???B ???????????????? 1.0~4.0cm,???????????????????????????
1.2 diagnostic basis. Early pregnancy refers to 35~60 days, urine HCG positive, B ultrasound confirmed intrauterine pregnancy, and the diameter of the gestational sac 1.0~4.0cm, excluding ectopic pregnancy. Preoperative blood routine and routine vaginal examination, and normal body temperature.
1.3 ????????
1.3 method of termination of pregnancy.
1.3.1 ??????????????????????????????????????? 20cm,????? 1.2cm???????????????????????????????????????????????????????????????????????????????????????????????????? 200 ???????????????????????????????????????????????????????????????2~3?????B???????????????????????????????????????????
1.3.1 group: no negative rotation without negative pressure the artificial abortion apparatus using rotating ring is made of polymer materials (the shank length is 20cm, the ring diameter of 1.2cm), before using the selected flow loop in uterus, into the uterine cavity after rotation ring. Vortex ring for high temperature disinfection products, disposable. The recipient bladder lithotomy position, cervical speculum exposed to conventional disinfection shop towels, enter the cyclone ring. Surgical ultrasound monitoring. Ultrasound alignment of the gestational sac, open the handle button, speed 200 rpm, clockwise rotation. The rotation of the gestational sac, peeling is clearly visible, with the rotation of the rotation ring gestational sac discharge outside the palace. The pregnancy sac discharge, again rotating ring rotating decidua, operation time is 2~3 minutes. Postoperative B ultrasound images can show clear uterine cavity line, suggesting that no tissue residue. After the operation, the rotational flow and the amount of bleeding were examined.
1.3.2 ????????????????????????????
1.3.2 traditional painless abortion group: the use of propofol anesthesia conventional negative pressure suction painless termination of pregnancy.
1.4 ????????
1.4 observation items and indicators.
1.4.1 ?????????????? WHO ??????????????0 ???????????????I ????????????1.4.2 ????????50ml????????????????? 10ml ??????????????????? 1~5ml ????6~10ml ????11~15 ????15ml ??????
1.4.1 to observe the pain during abortion: refer to WHO pain grading to observe the pain during the operation. 0 degrees: completely painless, a sense of soreness; I: mild pain, can endure; bleeding during 1.4.2: 50ml standard for measuring measurement of bleeding, such as the amount is less, with 10ml injection syringe blood measurement measuring cup bleeding; bleeding 1~5ml 6~10ml for a few 11~15 in the amount of 15ml, much more than.
1.4.3 ?????1???B????????????????
1.4.3 follow up: 1 weeks after the review of B ultrasound, to understand whether the residual or uterine cavity suction.
2 ??
2 Results
2.1 ?????????????????????????????????? 2~3 ????????????????? 3~4 ???????????
The 2.1 non negative pressure group and traditional painless group operation time. No negative pressure the average operation time was 2~3 minutes, the traditional painless group average operation time was 3~4 minutes, there was no big difference in time.
2.2 ??????????????????????????????????????? 5ml,??????????????? 10ml.
The 2.2 non negative pressure group and traditional group were painless vaginal bleeding compared with non negative pressure group the average amount of bleeding was 5ml, the traditional painless group the average intraoperative blood loss was 10ml.
2.3 2 ??????????????????? 250 ????????????????? 0~I ??50 ???????????????????? 0 ??
Comparison of abdominal pain in 2.32 groups of abortion. The non negative pressure group and 250 cases without any anesthetic, patients pain degree 0~I, 50 cases with nervous using propofol. Analgesia stream of people pain is 0 degrees.
2.4 2 ???????????????????????????? 1~3 ??? 11 ? 5~7 ????? 3.33%.???????????3~5???30?6~7???10%,??7??15??? 5%.
Comparison of the duration of vaginal bleeding between the 2.42 groups. The non negative pressure group after the bleeding time is short, the average 1~3 days, 5~7 days in 11 cases accounted for 3.33%. clean, painless group mean bleeding time 3~5 days, 6~7 days in 30 cases, accounting for 10%, more than 15 cases of 7 days, accounting for 5%.
2.5 2 ????????????????????????????????????
Comparison of 2.52 groups of abortion. The complete abortion group and the non negative pressure in traditional abortion group rate without too much difference.
2.6 ???????????? 4 ??????? 7 ??B ????????????????????????????????? 11 ??????? 7 ???? 6 ? B ???????????????? 0.1~0.2cm,?????“???”.5 ? B ???????????????????????
2.6 follow up. No negative pressure the group had 4 cases of vaginal bleeding more than 7 days, ultrasound examination revealed the uterus mixed light, vaginal bleeding after curettage. The traditional painless abortion group had 11 cases of vaginal bleeding more than 7 days, of which 6 cases ultrasound examination revealed endometrial echo uneven, the thickness of 0.1~0.2cm, no obvious "residue".5 cases ultrasound examination revealed intrauterine mixed light, vaginal bleeding after curettage.
3 ??
3 discussion
?????????????????????????????????????????????????????????????????????????????? 2 ?????????????????????????????????????????????????????????????????????
Painless induced abortion to improve the general flow of people to expand the palace and the pain of uterine suction, but the corresponding complications still exist, cervical mucosal injury, uterine wall damage, postoperative cervical adhesions, uterine adhesions. Painless increases the risk of anesthesia accident, there were 2 cases of anesthesia accident, after she turned the corner. Because of the anesthetic effect, the uterus becomes soft, with no consciousness, excessive suction palace, more prone to uterine perforation, due to excessive uterine aspiration caused by endometrial damage due to infertility.
??????????????????????????????[1]?????????????????????????????????????????????????[2]???10% ??????????????????
Some pregnant women because of the fear and the choice of drug abortion, but drug abortion bleeding, reported [1] bleeding and bleeding time was more than long and artificial abortion, may cause anemia, shock or secondary infection, medical abortion failure, needed curettage. Deng Shan et [2] reported that 10% of the patients after medical abortion of early pregnancy tissue residues required palace.
?????????????????????????? XRL ???????????????????????????????????????????????????????????????????????????????????????“????”????????“????”???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
No negative pressure the artificial abortion equipment selection Shandong Freda medical instrument limited company of XRL type rotating abortive apparatus, apparatus is a one-time rotating ring made of medical polymer materials instead of metal Straw past. Small volume, light weight, convenient operation; by rotation, winding, pull off and stripping way to discharge the pregnancy tissue from the palace cavity, with soft swirl ring "the role" to replace the metal Straw "suction" purpose to termination of pregnancy. The contact relation between the soft ring and the uterine wall for gestational sac full elastic contact, no damage to the basal layer of the endometrium; in the implementation of abortion without cervical dilation, without vacuum aspiration, greatly reduce the occurrence of postoperative complications, the abortion process in patients with pain or no pain, so patients completed surgery without anesthesia in the case of high security.
2 ??? 50 ???????????????????????????????????????????????????????2??????????????????????????????????????????????????????????????????????
2 groups of 50 cases of pregnancy after surgery to send pathology, pathological report shows: Uterine suction tissue more or less see the uterine wall cells. The pathology report showed no negative pressure group no uterine wall cells. Through the comparison of 2 groups: non negative pressure rotary flow and vacuum aspiration abortion compared in operation time, intraoperative blood loss, bleeding time after no significant difference. No negative pressure rotary flow menses with suction drainage early.
?????????????????????????????????????????? 1.0cm ??? 4.0cm ???????????????????????????????????????????????????????????????????
No negative pressure rotary abortion for clinical short time in clinical application is also insufficient, uterus anteflexion and retroflexion, the gestational sac is less than 1.0cm or greater than 4.0cm effect. Regardless of stream of people how to improve, it is more or less the damage to the uterus, so called for the majority of women of childbearing age, especially unmarried girls to choose the right method of contraception, to minimize the occurrence of abortion.
????
Reference
[1] ????????? . ????????????????????????? [J]. ??????????1997,6.
[1] Wei Min, Li Ming, Chu Yu. Observation of the time of vaginal bleeding after mifepristone combined with misoprostol for termination of early pregnancy [J]. Chinese Journal of family planning, 1997,6.
[2] ?????? . ??????? 81 ????? [J]. ??????????1999,5.
[2] Deng Shan, Huang Guangqiao. After drug abortion in the clinical analysis of 81 cases of [J]. Chinese Journal of family planning, 1999,5.