无痛人工流产术前阴道放置米索前列醇扩张宫颈口的适宜剂量

Recommended dosage of misoprostol for dilation of cervix before painless electrical vacuum abor-tions.

目的:无痛人工流产术(简称人流术)中宫颈的松弛程度是缩短手术时间和减少宫颈裂伤子宫穿孔的重要环节。基于国外研究证明米索前列醇(以下简称米索)的有效成分为 PGE_1,局部用药后不仅可以诱发子宫平滑肌收缩,更可以降解宫颈胶原纤维,软化宫颈。前瞻性对比研究不同剂量米索人流术前后穹窿放置扩宫效果以及副反应,了解用药后血中前列腺素水平变化。方法:选择孕40～60天未经阴道分娩的妇女303名,随机分成4组,于术前3～4小时阴道后穹窿放置米索,剂量分别为0、200、400、600μg,术中以用8、7或6号吸管能否顺利通过宫口衡量窗口扩张程度。静脉麻醉前抽静脉血 2ml,用放免法检测血浆 PGE水平。结果:米索放置剂量越大,宫口扩张程度越好,但腹痛、阴道流血等不良反应也越严重;随米索用量增加血中前列腺素水平明显升高。结论:放置400μg米索是适宜的选择,且用药方便,价格便宜,值得推广使用。

Objective: To evaluate the dilation of cervix and side effects after posterior fornix administration of misoprostol in different dosages, and the concentration of prostaglandin in serum was also detected. Methods: 303 non vaginal delivered women with 40-60 days gestation were randomly divided into four groups : posterior fornix administration of 200μg, 400μg, 600μg misoprostol 3-4 hours before electrical vacuum abortions,and control group without the misoprostol administration. The dilation of cervix was evaluated by the pass-through of 6#,7#,8# suction tubes. Blood samples were taken before vein anesthesia,PGE2 in serum was test by radioimmunologic methods. Results:With the in-creasing dosage of the misoprostol administration,the cervix was better dilated,but the side effects such as abdominal pain and vaginal bleeding was much more severe. And prostaglandin concentration in serum was increased as well. Conclusion: 400μg misoprostol administration is the recommended dosage. Because the misoprostol is cheap and posterior fornix administration can be done easily,so this method could be widely used.