足月妊娠胎膜早破引产米索前列醇的给药方法

Study on the Medication of Misoprostol to Induce Premature Rupture of Memberanes at Term

目的探讨米索前列醇(简称米索)用于足月妊娠胎膜早破引产的给药方法。方法符合试验条件的足月妊娠胎膜早破初产妇128例被随机分为3组米索口服组44例,50μg口服,每3小时1次,直至有效宫缩;米索直肠给药组48例,50μg直肠用药,每3小时1次,直至有效宫缩。两组一日最大剂量均为200μg;催产素引产组36例作为对照,按常规行催产素引产。结果(1)引产结果引产成功率、分娩方式、产后2h出血量、新生儿体重、新生儿Apgar评分、产后病率3组间比较,差异无显著性意义(P>0.05);经阴道分娩者,产程进入活跃期后宫缩不满意,需加用催产素静点促进宫缩的比率,米索口服组明显高于米索直肠给药组,差异有显著性(P<0.05)。(2)阴道分娩情况两米索引产组用药至有效宫缩时间相近,均短于催产素引产组,差异有显著性(P<0.01);第一产程、引产时间比较,米索直肠给药组明显短于米索口服用药组(P<0.01,P<0.05)及催产素引产组(P<0.05,P<0.01),而米索口服组与催产素引产组差异则无显著性意义(P>0.05)。(3)副作用米索口服组产程中宫缩不协调的发生率较高,因为个别病例未进行统计,该组羊水粪染率较高,而3组胎儿窘迫及新生儿窒息发生率之间的差异无显著性意义(P>0.05)。结论米索前列醇用于足月妊娠胎膜早破引产,采用50μg口服或直肠给药,均安全有效,但以直肠给药引产时间短、副作用小,值得推广。

Objective： To discuss the medication of misoprostol to induce premature rupture of memberanes（PROM） at term. Methods：One hundred and twenty eight primiparas with PROM at term pregnancy with inclusion criteria were divided into three groups randomly. Forty-four subjectsof oral group took orally misoprostol 50μg every 3 hours; 48 women of rectum group received the misoprostol 50 μg rectally every 3 hours; all subjects of the two groups received the drug constantly until the effective contraction and the largest dosage was 200 μg per day. Thirtysix women of oxytocin group were treated by oxytocin intervenous droping normally. Results： （1） The results of induction：There were no statistical differences in the success rate of labor induction, the delivery style , postpartum hemorrhage for 2 hours, the neonatal weight Apgar score, postparturm morbidity among the three groups（P^0. 05）. The incidence of inefficient contraction and oxytocin administration at active phase in oral group greatly higher than that in rectum group and oxytocin group for the delivery（P〈0.05）; （2）The condition of delivery： The interval from start of labor inducation to effective contraction was similar between the two misoprostol groups and was very significantly shorter than that in the oxytocin group（P〈0. O1）,the intervalof the first stage and the inducation in the rectum group was greatly shorter than that in the oralmisoprostol group（P〈0. 01 ,P〈0. 05） and oxytoein group （P〈0. 05,P〈0. 01） ,but the differenees between the oral group and the oxytoein group had no statistical significance （P〈0. 05）;（3）Side effects：The incidence of irregular contraction in the first stage and the incidence of meconium-stained amniotic fluid were higher in oral group, but the differences of the fetal distress andneonatal asphyxia in three groups had no statistical significance（P〉0. 05）. Conclusion： The method of misoprostol 50 μg rectally every 3 hours for the induced labor in the PROM at term is safe and effective and deserve generalization.