小剂量米非司酮配伍米索前列醇在彩超引导下吸宫终止剖宫产术后1年内早孕的临床研究

Small dose of mifepristone combined with misoprostol in early pregnancy termination within a year after cesarean section

目的:探讨小剂量米非司酮配伍米索前列醇在彩超引导下吸宫终止剖宫产术后1年内早孕的临床效果。方法:选取本院剖宫产术后1年内早孕(孕囊≤25mm)要求终止妊娠者200例,随机分成两组。对照组(100例)在彩超引导下直接吸宫,研究组(100例)晚饭后2h顿服米非司酮75mg,第2天早晨舌下含服米索前列醇400μg,30min后在彩超引导下吸宫。比较两组扩张宫颈、腹痛、术中出血量、人工流产综合反应、妊娠组织残留及子宫穿孔情况。结果:对照组全部需要扩张宫颈(100%),研究组10例需要扩张宫颈(10%);对照组人工流产综合反应发生率18%,研究组6%;对照组轻度、中度、重度腹痛分别为80%、14%、6%,研究组分别为95%、5%、0;对照组术中出血量为(16.3±2.5)ml,研究组为(12.3±2.1)ml。两组差异均有统计学意义(P<0.05),两组子宫穿孔和妊娠组织残留发生率比较均无统计学意义(P>0.05)。结论:小剂量米非司酮配伍米索前列醇在彩超引导下吸宫终止剖宫产后1年内早孕有较好的临床效果。

Objective： To explore the clinical effect of small dose of mifepristone combined with misoprostol in early pregnancy termination within a year after cesarean section. Methods： Totally 200 women with early pregnancy （gestational sac≤25 mm） within a year after cesarean section from January 2013 to December 2013 in Huai＇an Maternal and Child Health Care Hospital was chosen as the research subjects, and randomly divided into two groups. Women in the control group （n=100） underwent suction evacuation guided by color Doppler ultrasound, while those in the observa tion group （n= 100） were given small dose of mifepristone （75 mg） the night before and misoprostol （400 ug） sublingually 30 rain before the operation. The occurrence rates of dilatation of the uterine neck, abdominal pain, amount of bleeding, artificial abortion syndrome, pregnancy residue and uterine perforation were observed. Results.. The rate of dilatation of the uterine neck was 100% （100/100） in the control group and 10% （10/100） in the observation group. The rate of artificial abortion syndrome was 18% （18/100） in the control group and 6% （6/100） in the observation group. The rate of mild, moderate and severe abdominal pain were 80% （80/100）, 14% （14/100）, 6% （6/100） in the control group respectively, and 95% （95/100）, 5% （5/100）, 0 （0/100） in the observation group. In the control group, the amount of bleeding was （16.3±2.5） ml, while （12.3±2.1） ml in observation group, shouing a significant difference （P〈0.05）. The rate of uterine perforation was 2% （2/100） in the control group, and 0 （0/100） in the observation group （P 〉 0.05）. There was no significant difference in the pregnancy residue between two groups （P 〉 0.05）. Conclusion： Small dose of mifepristone combined with sublingual misoprostol before suction evacuation guided by color Doppler ultrasound in early pregnancy termination within a year after cesarean section is relatively safe, effective and would be worth popularizing.