不同剂量黄体酮治疗早孕先兆流产的临床分析

Clinical Analysis of Different Dose of Progesterone for The Treatment of Threatened Abortion

目的：探讨黄体酮剂量与早孕先兆流产妊娠结局的关系。方法：选择2009年6月-2011年6月在我院住院保胎治疗的早孕（6-12周）先兆流产的患者120例（均为自然受孕,首次妊娠）,随机分成三组,每组各40例,每例患者治疗前均做B超证实为“早孕活胎”,并应用免疫化学发光法检测血清孕酮（P）水平和血清β-HCG水平,均在正常范围内。A组：黄体酮20mg/日肌注至症状消失停药；B组：黄体酮40mg/日肌注至症状消失后减量为20mg/日肌注,一周后停药；C组：黄体酮60mg/日肌注至症状消失后减量为40mg/日,一周后减为20mg/日肌注一周停药。三组患者停药后再次出现流产征兆者仍应用原方案治疗。结果：（1）三组妊娠结局无明显差异性。（2）黄体酮所导致的副作用以C组最高,A组最低。（3）三组保胎成功者均已顺利生产,其新生儿均未见明显畸形。（4）C组保胎失败的患者中,稽留流产的发生率最高。结论：早孕先兆流产保胎治疗结局与黄体酮的使用剂量无直接相关性,而大剂量黄体酮使用后稽留流产发生率增高。

Objective：To explore the relationship between progesterone dose and pregnancy outcome in early pregnancy with threatened abortion. Methods：We selected 120 patients with threatened abortion for the first pregnancy and natural conception from June 2009 to June 2011 in our hospital,they were received miscarriage treatment of early pregnancy （6-12 weeks） .Those patients were randomly divided into three groups, 40 cases in each group . Before treatments, all patients were confirmed at early pregnancy with live births by ultrasound. Immunohistochemical chemiluminescence were used to detect serum progesterone （P） level and the level of serumβ-HCG, and All samples were within the normal range. Group A：progesterone （20mg/day） was admised by intramuscular injection until the symptoms disappeared; Group B; progesterone （40mg/day） was admised by intramuscular injection until the symptoms disappear, then reduction to 20mg/day for a week;Group C：progesterone（60mg/day） was admised by intramuscular injection until the symptoms disappear, then reduction to 40mg/day, and a week later was reduced to 20mg/day for a week. After drug withdrawal, if the three groups of patients emergenced abortion signs again, they were still used the original treatment. Results：（1） No significant differences were among the three groups patients’ pregnancy outcome. （2） The side effects caused by the progesterone were maxlmum in group C, and group A were minimum. （3） Three miscarriage winners groups had successful delivery, and their newborns showed no obvious deformity. （4） The highest incidence of missed abortion were finded among miscarriage patients in Group C. Conclusion：The pregnancy outcomes have no direct correlation with the dose of progesterone, and the incidence of missed abortion were increased after the use of high-dose progesterone in early pregnancy with threatened abortion.