不同剂量和用药途径对早期妊娠药物流产效果影响的系统评价

Effect of Different Dosages and Administering Approaches on Early Medical Abortion

目的:用循证医学的方法评价米非司酮配伍米索前列醇不同剂量、不同用药方法终止早孕药物流产的有效性。方法:计算机检索8个数据库、手工检索9种期刊,并追查参考文献,纳入国内外前瞻性临床对照试验,至少由两人独立评估文献质量和资料提取。数据分析采用软件Revman4.2完成。在异质性检验(P=0.05)后,无异质性者采用固定效应模型合并分析;有异质性者则分析异质性原因,并用敏感性分析、亚组分析或随机效应模型处理。结果:米非司酮<150mg组与150～200mg组的完全流产率、流产失败率和孕囊排除时间的差异均无统计学意义;米索前列醇口服组完全流产率低于阴道用药组,不完全流产率和流产失败率高于阴道用药组。结论:进一步减少米非司酮量(150mg)可能可行,需要深入研究米非司酮最低有效剂量。米索前列醇口服比阴道用药流产效果稍差,但口服用药更方便。

Objective： To compare the efficacy of different dosages of mifepristone in combination with misoprostol administered orally or vaginaUy for the early termination of pregnancy by methods of evidence based medicine. Methods ： Eight databases were searched, and nine journals were searched by hand. In addition, the eligible references were searched. At least two reviewers independently evaluated the quality and extracted data with confirmation of cross - check. Meta- analysis was performed by soft Revman 4.2. After heterogeneity test was done （ ct = 0.05 ）, data without heterogeneity was analyzed by fixed effect model, and those with heterogeneity was solved by sensitivity analysis, subgroup analysis or randomized effect model. Results： There was no significant difference in rate of complete abortion, rate of abortion failure and time of cyst excluding between less 150rag of mifepristone group and 150 - 200mg of mifepristone group. There was lower rate of complete abortion, higher rate of incomplete abortion and abortion failure in group of misoprostol administered orally. Conclusion： It might be possible to decrease the dosage of mifepristone. However, the lowest dosage with adequate effectiveness needs to be studied further. Misoprostol administered orally is less effective than that of the vaginal route, but it is more convenient.