米非司酮联合米索前列醇治疗早期稽留流产的效果及影响因素分析

Effect of Mifepristone combined with Misoprostol on early missed abortion and its influencing factors

目的 探讨米非司酮和米索前列醇联合作用对早期稽留流产的临床疗效及影响因素。方法 选取2020年12月—2022年5月湖州市妇幼保健院收治的132例孕早期稽留流产患者为研究对象,随机分为观察组与对照组,每组66例患者,另选取正常生产的孕妇132例为健康组。对照组给予米非司酮干预,观察组在对照组基础上联用米索前列醇干预;分析两组临床指标、住院时间、术中出血量及不良反应情况;单因素分析孕早期稽留流产的影响因素,多因素logistic回归分析影响孕早期稽留流产的危险因素。结果 观察组阴道出血量、平均排胎时间、住院时间及术中出血量较对照组均更低(t=2.195,5.483,22.376,19.751,均P<0.05);两组患者治疗后β-hCG指标均降低,但仅观察组与治疗前比较差异有统计学意义(t=57.352,P<0.05),组间比较结果显示观察组显著低于对照组,差异有统计学意义(t=45.646,P<0.05);治疗结束后两组患者的TNF-α、HIF-1α及Hcy水平均明显下降,组间比较显示观察组显著低于对照组,差异均具有统计学意义(t=18.673,16.214,-29.520,均P<0.05);多因素logistic回归分析发现,被动吸烟、高龄妊娠、未进行脱畸检查及体质量>60 kg为早期稽留流产的危险因素。结论 米非司酮联合米索前列醇干预对早期稽留流产患者具有一定临床疗效和较高安全性,值得广泛应用于临床;且被动吸烟、高龄妊娠、脱畸检查及体质量均与早期稽留流产密切相关,应着重对此观察,尽量减少早期稽留流产发生率。

Objective To explore the clinical effect of combined action of mifepristone and misoprostol on early missed abortion and the influencing factors.Methods A total of 132 missed abortion patients in early pregnancy admitted to our hospital from December 2020 to May 2022 were selected as research objects and randomly divided into study group and control group,with 66 patients in each group.Another 132 pregnant women with normal childbirth in our hospital were selected as healthy group.The control group was given mifepristone intervention,and the observation group was given misoprostol intervention on the basis of control group.Clinical indexes,length of hospital stay,intraoperative blood loss and adverse reactions of the two groups were analyzed.Univariate analysis of the factors affecting missed abortion in the first trimester,multivariate logistic regression analysis of the risk factors affecting missed abortion in the first trimester.Results Compared with the control group,the amount of vaginal bleeding,the average time of abortion,the length of hospital stay and the amount of intraoperative bleeding in the study group were lower(t=2.195,5.483,22.376,19.751,all P<0.05).After treatment,the β-hCG index of the two groups decreased,but only the difference between the study group and before treatment was statistically significant(t=57.352,P<0.05).The comparison between the two groups showed that the study group was significantly lower than the control group,and the difference was statistically significant(t=45.646,P<0.05).After treatment,the levels of TNF-α,HIF-1α and Hcy in the two groups were significantly decreased,and the comparison between the two groups showed that the study group was significantly lower than the control group,and the differences were statistically significant(t=18.673,16.214,-29.520,P<0.05).Multivariate logistic regression analysis showed that passive smoking,advanced pregnancy,unperformed teratosis examination and weight 60kg were risk factors for early missed abortion.Conclusion The intervention of mifepristone combined with misoprostol has certain clinical efficacy and high safety for early missed abortion patients,and is worthy of widespread clinical application.In addition,passive smoking,advanced pregnancy,teratoscopy and weight are closely related to early missed abortion,which should be emphasized to reduce the incidence of early missed abortion.