米索前列醇联合米非司酮用于手术终止瘢痕子宫中期妊娠疗效观察

Randomized control study of misoprostol combined with mifepristone in termination of middle pregnancy with scarred uterus

目的观察米索前列醇联合米非司酮应用于手术终止瘢痕子宫中期妊娠的效果。方法选取2011年10月至2013年11月间我院产科收治的90例瘢痕子宫中期妊娠并自愿终止妊娠者为研究对象,随机将其分为观察组48例与对照组42例,观察组术前予口服米非司酮,肛塞米索前列醇处理,对照组常规实施无痛人流术,对比两组术中宫颈软化情况及出血量、手术时间、人流综合征发生率等指标。结果两组患者术中宫颈软化程度总体构成差异有统计学意义(Z=2.075,P=0.038),观察组宫颈软化优良率为93.8%,高于对照组的81.0%,但差异无统计学意义(χ2=3.420,P=0.064)。观察组与对照组术中出血量、手术时间、术后阴道出血天数、人工流产综合征发生率分别为(79.7±22.3)ml vs(108.3±28.2)ml、(2.7±0.8)min vs(5.0±1.5)min、(3.1±1.0)d vs(4.7±1.6)d、2.1%vs 14.3%,差异均具有统计学意义(P<0.05)。观察组用药后发生的轻度恶心、呕吐、发热等不良反应均耐受。结论瘢痕子宫中期妊娠者人流术前采用米非司酮联合米索前列醇能较好软化宫颈,降低手术难度与人流综合征的发生率,药物不良反应较轻可控。

Objective To explore the clinical efficacy of misoprostol combined with mifepristone in termination of middle pregnancy for patients with scarred uterus. Methods Ninety patients with scarred uterus from Oct2011 to Nov 2013 were selected as study objects, which were randomly divided into observation group（48 cases） and control group（42 cases）. Patients in the observation group preoperatively received mifepristone orally and plug misoprostol anally, while patients in the control group were routinely practiced painless induced abortion. The cervix softening, bleeding volume, operation time and incidences of abortion syndrome in the two groups were compared.Results Constitution of cervical softeningdegree in the two groups had significant difference（Z=2.075,P=0.038）. The excellent and good ratio of cervical softening in the observation group was higher than that in the control group（93.8%vs 81.0%） with no statistically significant difference（χ^2=3.420, P=0.064）. The bleeding volume, operation time, postoperative vaginal bleeding days, and incidences of abortion syndrome in the observation and control group were（79.7 ±22.3） ml vs（108.3±28.2） ml,（2.7±0.8） min vs（5±1.5） min,（3.1±1） d vs（4.7±1.6） d, 2.1% vs 14.3%, respectively, in which the differences were of statistically significant（P〈0.05）. The mild nausea, vomiting, fever and other adverse reactions occurred in the observation group after treatment could tolerance. Conclusion In artificial abortion for middle pregnancy cases with scarred uterus, given mifepristone and misoprostol preoperatively can soften the cervix, decrease the operation difficulty, incidences of induced abortion syndrome and lighten the adverse drug reactions.