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[摘要] 目的:探讨米非司酮配伍米索前列醇片在稽留流产中的应用效果。方法:对2008年1月～2010年2月对妊娠12～18周稽留流产孕妇102例,按入院时间顺序单数选为实验组(A组),双数选为对照组(B组),各51例,实验组服用米非司酮配伍米索前列醇片,与对照组苯甲酸雌二醇肌注后再行清宫术比较。结果:实验组完全流产43例,占84.3%;不全流产7例,占13.7%;流产失败1例,占2.0%。阴道流血量60 ml 6例,占12%;清宫人数8例,清宫时间5 min 0例。对照组完全流产3例,占5.8%;不全流产4例,占7.8%;流产失败44例,占86.4%。阴道流血量60 ml 20例,占44%。清宫人数48例,清宫时间5 min 6例,占12.5%。结论:米非司酮配伍米索前列醇在稽留流产中应用效果显著,值得临床推广应用。
[关键词] 米非司酮;米索前列醇;稽留流产;清宫术;阴道出血量
[中图分类号] R979.2+2 [文献标识码]B [文章编号]1674-4721(2010)05(a)-056-02
The clinical application of Mifepristone and misoprostol in missed abortion
LIU Qunxiang,WANG Wei
(Zhangmutou People"s Hospital of Dongguan City,Guangdong Province, Dongguan 523633, China)
[Abstract] Objective: Investigated the effect of mifepristone and misoprostol in the clinical application of missed abortion.Methods: 102 cases of pregnant women with 12 to 18 weeks of pregnancyfrom January 2008 to February 2010,according to the hospitalized time, the singular numbers were selected for the experimental group,and even numbers were selected as the contrasting group,with each 51 examples. The experimental group was given mifepristone and misoprostol while the contrasting group was given intramuscular injection of estradiol benzoate curettage and complete curettage of uterine cavity. Results: For the experimental group,there were 43 cases of complete abortion, accounting for 84.3%; 7 cases of incomplete abortion,accounting for 13.7%;1 case of missedabortion, accounting for 2.0%;45 cases for the vaginal bleeding volume 60 ml,accounting for 12%;Of the 8 cases of complete curettage of uterine catity,there were 8 cases of the complete curettage of uterine cavity time 5 minutes. For the contrasting group, there were 3 cases of complete abortion,accounting for 5.8%;4 cases of incomplete abortion, accounting for 7.8%;44 cases of missedabortion,accounting for 86.4%;vaginal bleeding volume 60ml, 20 cases, accounting for 44%; Of the 48 cases of complete curettage of uterine cavity, there were 42 cases of the complete curettage of uterine cavitytime 5 minutes,accounting for 22.5%. Conclusion: Mifepristone and misoprostol in the application of missed abortion effect is remarkable,should be widely applied.
[Key words] Mifepristone; Misoprostol; Missed abortion; Complete curettage of uterine cavity; Vaginal bleeding
稽留流产亦称过期流产,系指胚胎或胎儿已死亡而稽留于宫腔未能及时自然排出[1]。妊娠10～14周采用钳刮术技术难度高,子宫内膜损伤大,并发症多,一直是计生工作者棘手的问题[2]。现将本院2008年1月～2010年2月102例分别采用米非司酮配伍米索前列醇治疗与肌注苯甲酸二醇后再清宫治疗的疗效比较分析如下:
1 资料与方法
1.1 一般资料
选择2008年1月～2010年2月本院稽留流产住院患者102例,年龄20～40岁,平均30.1岁;妊娠12～18周,妇科检查及B超证实无胎心,凝血机制正常,均无肝肾疾病,无青光眼、哮喘、癫痫及过敏史。102例孕妇中初产妇35例,占34.3%;经产妇67例,占65.7%。所有宫口未开,子宫均少于孕周,相当于8～12周,入院前有或无少量阴道出血,无肉样组织排出。
1.2 方法
按入院顺序将单数选为实验组(A组),双数选为对照组(B组)。A组孕妇早晨空服米非司酮片50 mg后改为每次25 mg,12 h 1次,共4次,总剂量为150 mg,第5次服药15 min后口服米索前列醇600 μg,然后行清宫术;B组:肌注苯甲酸雌二醇4 mg,每日2次,连续3 d,第4天行清宫术。
1.3 疗效评估
完全流产:绒毛(胎儿)、胎盘排出,阴道出血少,2 d后复查B超示宫腔内无残留物,不需清宫者。不全流产:阴道出血量60 ml,超过24 h绒毛(胎儿)、胎盘未排出,需行清宫者,清宫时间长。
1.4 统计学分析
采用t检验。
2 结果
2.1 用药后流产情况比较
见表1。
2.2 阴道流血及手术时间比较
见表2。
2.3 副作用
A组米非司酮配伍米索前列醇片用于稽留流产治疗51例患者,偶有恶心、呕吐、眩晕、腹痛、腹泻、血压升高等副作用,症状轻微,消失快。B组51例患者苯甲雌二醇注射液也出现有恶心、头痛、乳房胀痛等副作用。
3 讨论
3.1 作用机制
米非司酮作用于妊娠子宫,最初表现为蜕膜退行性变,致使胚囊与蜕膜分离,继而人绒毛膜促性腺激素分泌下降,使黄体分泌孕酮减少,同时米非司酮作为孕激素受体的拮抗剂,影响孕激素的生物化学反应,使蜕膜变性、坏死,继而导致绒毛供血不足,胚胎停止发育,这是米非司酮抗早孕的重要药理作用[3]。同时米非司酮还能使子宫内膜释放前列腺素,促进子宫颈软化,子宫收缩;米索前列醇片是前列腺素E的衍生物,能促进宫颈成熟,增强子宫张力及宫内压作用;该两药合用有良好的终止妊娠及促进胚胎排出的作用[4]。而稽留流产患者因其蜕膜、绒毛已变性、坏死,激素水平已处于较低水平。用米非司酮很易干扰体内雌激素受体与孕激素受体间的平衡,使雌二醇增加,从而提高了子宫敏感性和抗孕酮作用而导致流产。
3.2 疗效
稽留流产是流产的一种特殊类型,在临床处理上有一定难度。胎盘组织机化与子宫肌壁紧密粘连,致使刮宫困难,稽留时间长,可能发生凝血功能障碍,导致弥散性血管内凝血,造成严重出血[1]。传统采用苯甲酸雌二醇肌注后再行清宫术,清宫率高,需要扩宫,清宫时间长,并发症多,患者很痛苦。本院采用的服用米非司酮配伍米索前列醇片治疗稽留流产,效果显著。从表1可知,流产有效率高,清宫率低,P
