无痛人工流产术前直肠放置米索前列醇的适宜剂量

Optimal Rectal Dosage of Misoprostol for Dilation of Cervix Before Painless Electrical Vacuum Abortions

目的前瞻性对比研究无痛人工流产术（人流术）前直肠放置米索前列醇的适宜剂量。方法选择孕40-60d未经阴道分娩的妇女240例，随机分成A、B、C3组，每组80例，于术前1h直肠放置米索前列醇，剂量分别为200，400和600μg，比较3组患者宫颈扩张程度、术中出血量和用药不良反应。静脉麻醉前抽取静脉血2mL，采用高效液相色谱．质谱联用法检测米索前列醇酸的血药浓度。结果3组镇痛优良率均为100．00％。A、B、C组宫颈扩张显效有效率为23．75％，46．25％和70．00％，但阴道流血、腹痛等不良反应随剂量增大也越严重，米索前列醇酸的血药浓度分别为（117±65），（206±98），（303±149）pg·mL^-1。结论直肠放置米索前列醇400μg是无痛人流产术前适宜的选择，效果可靠，用药方便，经济安全，值得临床推广应用。

Objective To evaluate the optimal dosage of misoprostol administered in the rectum for dilation of the cervix. Methods Two hundred and forty women at 40-60 day gestational age without vaginal delivery history were randomly divided into three groups, with 80 cases in each group. Patients received 200,400 or 600 μg of misoprostol rectally one hour before electrical vacuum abortions in group A, B and C, respeetively. Cervical dilation, blood loss, and drug side effects in the three groups were compared. Venous blood samples were taken before vein anesthesia, and misoprostol acid concentration in the serum was tested by liquid chromatography-mass spectrometry. Results The analgesic rate was 100.00% in all three dose groups, and cervical dilation rate was 23.75% ,46.25% and 70.00% in groups A, B and C ,respectively. The severity of drug side effects such as vaginal bleeding and abdominal pain is dose-dependent. Blood concentration of misoprostal acid was （117±65 ） ,（ 206± 98 ）,and （303±149） pg · mL^-1, in groups A, B and C, respectively. Conclusion The recommended dose of misoprostol is 400 μg administered in rectum. Rectal administration of misoprostol is cheap, safe, and convenient, and therefore could be widely applied.