保守治疗人工流产术后残留效果及相关因素探讨

Effect of conservative treatments for incomplete induced abortion and the factors related to successful removal of the remnants

目的:探讨影响人工流产术后残留保守治疗的相关因素,为临床有效诊断提供和治疗依据。方法:采用单纯随机抽样方法,选取101例人工流产术后残留者,随机分成米非司酮不同剂量3组(50mg/d×28d,100mg/d×14d,200mg/d×7d)和对照组,比较各组治疗效果;根据治疗效果分为治愈组和非治愈组,比较年龄、体重、孕产次、治疗后出血时间,血β-hCG基线值、B超测得的残留物大小等指标,采用秩和检验及logistic回归方法分析影响米非司酮治愈人工流产后残留的相关因素。结果:米非司酮200mg/d×7d剂量组治愈率最高(P<0.05)。治愈组较未治愈组血β-hCG值低,宫内残留组织小,治疗后出血时间短,残留组织血流阻力指数大(P均<0.05)。logistic回归分析表明,米非司酮的剂量、血β-hCG基线值、B超下宫内残留组织大小、宫内残留组织血流阻力指数与治疗效果相关(P<0.05)。结论:人工流产术后残留采用米非司酮治疗时,短时间大剂量应用最为有效。血β-hCG基线值、宫内残留物大小和血流阻力指数是判断治疗效果的主要相关因素。

Objective： To study the effect of conservative treatments for abortive remnants of induced abortion, and probe into the influencing factors related to the successful removal of the remnants. Methods ： A total of 101 patients with abortive remnants after induced abortion were selected by simple random sampling, and randomly divided into 4 groups, with 3 groups treated with different dosages of mifepristone （50 mg/d × 28d, 100 mg/d × 14d, and 200mg,/d × 7d）and 1 control group. Based on the treatment outcomes, the patients were subgrouped into cured group and uncured group. The parameters of age, weight, gravidity, parity, bleeding time after treatment, baseline [3- hCG （human chorionic gonadotrophin） levels, and the size of abortive rem- nants measured by B -mode ultrasonic diagnostic equipment were analyzed. Rank sum test and logistic regression method were used to analyze the correlated factors with successful treatment of abortive remnants of induced abortion with mifepristone. Resuits ： The group with mifepristone 200mg/d x 7d showed the most effective results （ P 〈 0. 05 ）. Compared with the uncured group, cured group had lower levels of serum β - hCG, smaller abortive remnants, shorter bleeding time after treatment, greater resistance index of blood flow （P 〈 0.05 for all above factors）. Logistic regression analysis showed that dosage of mifepristone, baseline β - hCG, the average size of the abortive remnants, and resistance index of blood flow status of the remnant tissue were closely correlated to the treatment outcomes （P 〈 0.05 ）. Conclusion ： Mifepristone was effective in the treatment of incomplete induced abortion, and it was most effective when used at a short - term high dose. The baseline β - hCG, size of the abortive remnants and resistance index of bleed flow of the abortive remnants could predict the treatment outcomes.