米索前列醇用于人工流产术前宫颈扩张给药时间的观察

The optimal time interval between oral misoprostol and artificial abortion for cervical priming: a random prospective trial

目的 探讨口服米索前列醇用于人工流产术前宫颈软化扩张适宜的给药时间。方法 采用前瞻性对比研究 ,将 1 97例早孕妇女随机分为米索前列醇 4 0 0 μg术前 1h服、米索前列醇 4 0 0 μg术前 2h服用、米索前列醇 4 0 0 μg术前 1h服用配伍 1 %利多卡因宫颈 3点、 9点各注射 2ml以及不采用任何药物的A、B、C、D四组。观察并比较各组宫颈松弛程度、扩宫难易度、手术效果、疼痛程度、术前术后宫腔长度差、手术时出血量及人流综合征等参数。结果 A、B、C组在术前宫颈松弛度和扩宫难易度方面差异无显著性 (P >0 0 5 )。而A、B、C组与D组比较差异具有极显著性 (P =0 0 0 0 )。手术效果以及疼痛评分比较 :A组与B组比较差异无显著性 (P >0 0 5 ) ,A、B组与C组之间差异有显著性 (P =0 0 0 9、P =0 0 0 8) ;A、B、C组与D组比较差异有极显著性 (P =0 0 0 0 )。宫腔长度差及出血量在A、B、C、D组之间差异均无显著性 (P >0 0 5 )。A、B、C组均无人流综合征发生 ,D组 1例人流综合征。结论 人工流产术前口服米索前列醇 4 0 0 μg可以有效地软化扩张宫颈 ,减少受术者痛苦 ;术前 1h和 2h用药同样可以有效地软化扩张宫颈 ;口服米索前列醇配伍利多卡因宫颈局部麻醉镇痛效果更佳。

Objective To determine the optimal time interval between the use of oral misoprostol for cervical priming and first-trimester vacuum aspiration abortion. Methods A prospective study was carried out with 197 healthy women requesting legal termination of pregnancy between 5 and 9 weeks of gestation, who were randomly allocated into four groups: Group A orally took 400 μg of misoprostol 1 hour pre-operation, Group B 2 hours pre-operation, Group C orally took 400 μg of misoprostol 2 hours pre-operation and cervix injected 4 ml of 1% Lidocaine 5 min before abortion, Group D administered no drugs. Cervical relaxing, ease of further cervical dilation, lower abdominal pain, effect of operation, uterotonic degree, operative blood loss and occurrence of RAAS were observed. Results There was no significant difference on cervical relaxing, ease of further cervical dilation among Group A, B, C ( P >0 05), yet the effects were better in Group A, B, C when compared with Group D ( P =0 000). Group A and B obtained similar effect on lower abdominal pain and operative efficiency ( P >0 05), which were worse than Group C ( P =0 008) and better than Group D ( P =0 000). There was no significant difference on uterotonic degree, operative blood loss among the four groups. No RAAS in Group A, B and C, and 1 case of RAAS in Group D. Conclusions Either one or two hours before first trimester abortion, 400 μg of oral misoprostol can successfully help in cervical priming, and combination of cervix-injected Lidocaine could make it more effective.