米非司酮用于足月妊娠引产的临床观察

MifepristoneforInductionofLabor

目的：观察米非司酮用于足月妊娠的促宫颈成熟与引产作用。评价其对母儿的安全性。方法：选择１２４例妊娠３７～４２周有引产指征未产妇，随机分为两组，米非司酮组６２例，服米非司酮５０ｍｇ，每天２次共２天，第３天分别给予卡前列甲酯栓（ＰＧ０５）及催产素（各３１例）引产。对照组６２例观察２天，第３天分别用ＰＧ０５及催产素引产。观察各项产科参数。各组均于头盆衔接时，分娩后立即抽血，分娩时并抽脐静脉血，测定米非司酮浓度及雌、孕激素，睾酮，皮质醇，醛固酮及胎盘泌乳素水平。结果：米非司酮具有明显的促宫颈成熟作用，米非司酮组宫颈Ｂｉｓｈｏｐ评分增加明显，并优于对照组（Ｐ＜０．００１），且具有一定的引产效果。米非司酮组引产成功率（８２．２６％）优于对照组（６２．９０％）（Ｐ＜０．０５），并且减少催产素用量（Ｐ＜０．０５）。副反应主要为轻度恶心及呕吐。母血米非司酮峰值范围２００～７００μｇ／Ｌ，根据ＮＤＰ法计算的消除半衰期约为２１．７小时。脐血米非司酮浓度波动于３４～１４２μｇ／Ｌ之间，不与母血水平呈一级速率关系。脐／母血药比值为０．２５±０．０８。母血及脐血各种激素测定，米非司酮治疗组与对照组之间无差异。结论：米非司酮具有促宫颈成?

Objectives:Toevaluatetheefectivenessofmifepristoneadministeredpriortolaborinduction,andtostudyitssafetyformotherandfetus.Methods:124nulipara,37～42gestationalweeks,withindicationsforlaborinductionwererecruited,andrandomlyalocatedinto2groups.GroupA(n=62)wasgivenmifepristone50mgq.12.h.for2days,folowedbyPG05oroxytocin,whilegroupB(n=62)waswereobservedfor2daysbeforelaborinductionbyPG05oroxytocin.Bloodsampleswereobtainedfordeterminationofmifepristoneconcentrationandhormonelevelsin-cludingestradiol,progesterone,testosterone,cortisol,aldosteroneandhumanplacentalprolactinatrecruitmentandimmediatelyafterdelivery,andumbilicalcordbloodwascolectedatthesametime.Results:CervicalBishopscoreincreasedsignificantlyinthemifepristonepretreatmentgroupwhencomparedwiththecontrolgroup.22.58%ofthewomenunderwentspontaneousdeliveryaftermifepristonetreatmentand4.84%ofthecontrolsfolowedsuit(P<0.01).Theoxytocindosere-quiredwassignificantlylessingroupA,butthesuccessratewashigher(P<0.05).Side-efectsas-sociatedwithmifepristonewasmild.Maternalserummifepristonepeaklevelsrangedfrom200to700μg/L,witht1/2of21.7hr.Theconcentrationofmifepristoneinumbilicalbloodwaslowandsta-ble.Theratioofumbilical/maternalmifepristonelevelwas0.25±0.08.Determinationofhormoneprofilesdidnotshowanysignificantdiferencebetweenthe2groups.Conclusions:Mifepristoneisaneffectiveinductiveagentforcervicalripeningandinitiationoflaborintermpregnancy,andcanim-provetheoutcomeoflaborinduction.