地诺前列酮栓剂用于足月妊娠促宫颈成熟和引产的临床评价

Clinical evaluation of dinoprostone pessary for cervical ripening and labor induction in term pregnancy

目的:评价控释地诺前列酮阴道栓剂(普贝生)用于足月妊娠促宫颈成熟及引产的有效性及安全性。方法:采用随机对照研究的方法,对80例无阴道分娩禁忌、妊娠足月、宫颈Bishop评分≤6分的初产妇随机分为研究组和对照组,每组40例,研究组采用阴道内使用地诺前列酮,对照组静脉滴注小剂量缩宫素。比较两组产妇宫颈Bishop评分、分娩情况以及对胎儿、新生儿的影响。结果:①两组用药前宫颈Bishop评分分别为(4.23±1.025)分和(4.15±1.099)分,而用药后12 h,研究组宫颈Bishop评分为(7.75±2.227)分,对照组为(6.38±2.862)分,宫颈评分的差异有显著性统计学意义(P<0.05)。②经阴道分娩产妇中,研究组临产发动时间、产后2 h出血量明显少于对照组,两组差异有显著性统计学意义(P<0.05)。研究组12 h临产率(57.5%)明显高于对照组(35%),差异均有显著性统计学意义(P<0.05)。③剖宫产率、胎儿宫内窘迫、新生儿出生时情况,两组比较差异无统计学意义(P>0.05)。宫缩过频过强为地诺前列酮的主要不良反应,研究组发生2例,但取出地诺前列酮栓剂后好转。结论:地诺前列酮促宫颈成熟效果明显优于缩宫素,它是一种有效、安全和方便的促宫颈成熟和引产的药物。

Objective： To evaluate the efficacy and safety of controlled-release dinoprostone pessary （propess） in cervical ripening and intermediate labor induction. Methods： Eighty primiparas with uterogestation and Bishop score ≤6 points and no vaginal delivery taboo were equally divided into a study and a control group. The former received intravaginal administration of propess and the latter intravenous injection of low-dose oxytocin by the randomized control method. Comparisons were made of the Bishop score, delivery and the state of the fetuses and neonates between the two groups. The side effects of propess were observed. Results ： Bishop scores were 7.75 ± 2. 227 and 6.38 ± 2. 862 in the study and the control group respectively 12 hours after the medication, significantly higher than 4.23 ± 1. 025 and 4.15± 1. 099 before the induction （ P 〈 0.05 ）. The rate of labor induction at 12 hours was also significantly higher in the former （57.5%） than in the latter （35%） （P 〈 0.05）. No statistical differences were observed in the rate of Cesarean section and the state of the fetuses and neonates between the two groups （P 〉 0.05）. The major side effect of propess was the over-frequent and over-strong contraction of the uterine, which occurred in 2 cases in the study group but subsided after its removal. Conclusion： Dinoprostone pessary, effective, safe and convenient, is obviously superior to oxytocin in cervical ripening and labor induction.