米非司酮治疗人工流产术后残留的临床观察

Clinical efficacy and safety of mifepristone in the treatment of abortive remnants of induced abortion

目的 探讨不同用药方案的米非司酮治疗人工流产术后残留的有效性及安全性.方法 对象为自2009年10月至2011年2月复旦大学附属妇产科医院计划生育门诊就诊的流产后妇女,通过B超及血β-人绒毛膜促性腺激素（HCG）明确诊断为残留的对象,共101例,随机分为4组.按每日服用米非司酮计量不同分3组（3组计量分别是200 mg 7 d,100 mg 14 d,50 mg 28 d）,另设对照组（服头孢呋辛酯）,通过临床观察,B超及血β-HCG监测,比较4组的治疗效果及安全性.结果 米非司酮治疗组有效率61.60％（45/73）,对照组治疗有效率21.40％（6/28）,两者比较差异有统计学意义（P＜0.01）.用药2周后血β-HCG和B超结果,治疗组明显好于对照组,差异有统计学意义（P＜0.01）,其中大剂量组治疗效果最为明显；用药4周后米非司酮治疗3组间血β-HCG差异无统计学意义（P＞0.05）,3组间宫内残留组织物缩小差异有统计学意义（P＜0.05）,其中短时间大剂量组缩小最为明显.4组的阴道流血停止时间、转经时间差异有统计学意义（P＜0.05）.治疗3组在治愈时间上差异无统计学意义（P＞0.05）.治疗3组不良反应的发生率差异无统计学意义（P＞0.05）.结论运用米非司酮保守治疗人工流产术后残留有效,而且短时间大剂量的给药方式更有效.

Objective To evaluate the efficacy and safety of treating abortive remnants of induced abortion with different doses of mifepristone.Methods A total of 101 women undergoing post-abortion treatment at our family planning clinic from October 2009 to February 2011 were recruited and divided randomly into 4 groups.They were diagnosed as abortive remnants by ultrasound and blood level of β-HCG （human chorionic gonadotrophin）.Three test groups received different doses of mifepristone and one group as control. The efficacy and safety of four groups were evaluated by clinical observations,ultrasonic examinations and blood level of β-HCG.Results The effective rates of mifepristone test and control groups were 61.60% and 21.40% respectively.And there were statistical significances between two groups （ P 〈 0.01 ）.After a 2-week treatment,the changes of blood level of β-HCG and reduction of residual size tested by ultrasound were better than those of the control group.And there were significant statistical differences （P 〈0.01 ）. The group with high dose in short term achieved the best outcomes. After four weeks of treatment,blood level of β-HCG of test groups had no statistical significance （ P 〉 0.05 ）.There was statistical significance in pairwise comparison on reduction of residual size tested by ultrasound among test groups （ P 〈 0.05 ）. The high-dose group with achieved the largest short-term reduction. Statistical significances existed in the hemostatic time of vaginal hemorrhage and menstrual recovery between three test groups and the control group （ P 〈 0.05 ）. No statistical significance was found in healing time and the occurrence of adverse events among these 3 test groups （ both P 〉 0.05 ）.Conclusion Mifepristone is effective in the treatment of induced incomplete abortion.And a short-term large dose offers a better efficacy.