米非司酮在子宫肌瘤合并贫血术前预处理中的应用价值

The value of the Mifepristone in preoperative pretreatment of uterine fibroids merger moderately severe anemia

目的探讨米非司酮在子宫肌瘤合并中重度贫血患者术前预处理中的价值。方法选择2010年1月~2013年12月苏州大学附属太仓医院子宫肌瘤合并中重度贫血患者93例为研究对象,将其分为用药组（61例）和输血组（32例）。给予用药组患者口服米非司酮12.5 mg,每日1次,同时辅助以口服琥珀酸亚铁,待贫血纠正后住院手术治疗;输血组患者未用药,直接输血后手术治疗。比较分析两组患者的手术时间、术中出血量、住院费用、住院天数、术后发热及切口渗液等情况。结果治疗后,用药组患者的血红蛋白由（78.46±10.09）g/L上升到（104.23±19.71）g/L,差异有统计学意义（P〈0.05）;用药组的血清雌二醇、黄体酮以及促黄体激素水平显著低于输血组,差异有统计学意义（P〈0.05）。输血组手术时间、住院天数、住院费用、术后病率明显高于用药组,差异有统计学意义（P〈0.05）;用药组的总有效率为95.08%（58/61）,显著高于输血组的81.25%（26/32）,差异有统计学意义（χ2=4.59,P〈0.05）。治疗期间,两组不良反应主要为恶心、乏力及眩晕,输血组不良反应发生率为9.38%,用药组为6.56%,两组比较,差异无统计学意义（χ2=0.24,P〉0.05）。结论术前短期应用小剂量米非司酮及口服补血药可以有效纠正子宫肌瘤合并中重度贫血者的贫血状态,降低医疗费用及手术对患者的损伤,同时节省血源以缓解用血紧张矛盾。

Objective To investigate the preoperative value of Mifepristone in treatment of uterine leiomyoma with se-vere anemia. Methods 93 patients with uterine fibroids and moderate to severe anemia from January 2010 to December 2013 in Taicang Hospital of Suzhou University were selected as study objects, and they were divided into treatment group （61 cases） and blood transfusion group （32 cases）. Patients of the treatment group were accepted mifepristone 12.5 mg orally, 1 time per day, and aided by oral amber acid ferrous at the same time, they were given the operation after anemia correction;patients in blood transfusion group were treated without medication, operation treatment direct-ly after blood transfusion. The operation time, intraoperative blood loss, hospitalization expenses, hospitalization time and postoperative fever, incision drainage of two groups were compared and analyzed. Results After treatment, the level of hemoglobin in treatment group [（78.46±10.09） g/L）] increased to （104.23±19.71） g/L, the difference was statistically significant （P〈0.05）;the serum levels of estradiol, progesterone and luteinizing hormone levels of treatment group were lower than those of the blood transfusion group, the differences were statistically significant （P〈 0.05）. The operation time, hospitalization days, cost of hospitalization, postoperative morbidity transfusion group were higher than those of the treatment group, the differences were statistically significant （P〈 0.05）; the total cure rate of treatment group was 95.08%（58/61）, higher than that of the blood transfusion group [81.25%（26/32）], the difference was statistically signifi-cant （χ2=4.59,P〈 0.05）. During the treatment, nausea, fatigue, dizziness were the main adverse reaction of the two groups, the incidence rate of adverse reaction in the treatment group was 6.56%, the transfusion group was 9.38%, the adverse reaction rate of both groups has no statistical significance （χ2=0.24, P〉 0.05）. Conclusion Preoperative low-dose short-term application of Mifepristone and oral drug blood can effectively correct the anemia status of patients with uterine fibroids and moderate and severe anemia, reduce the injury and operation costs, while saving blood to re-lieve the tense contradiction with blood.