米非司酮联合米索前列醇对瘢痕子宫妊娠引产的效果及安全性分析

Analysis on the efficacy and safety of mifepristone combined with misoprostol for induced abortion of cesarean scar pregnancy

目的:评价米非司酮联合米索前列醇在瘢痕子宫中期妊娠引产的效果、安全性及其临床适用性。方法:选择接受治疗的86例瘢痕子宫中期妊娠患者随机分为试验组和对照组各43例,对照组患者采用米非司酮联合利凡诺羊膜腔注射引产,试验组患者采用米非司酮联合米索前列醇进行引产。观察两组患者的引产效果、引产时间(包括用药至宫缩发动时间、宫缩至胎儿胎盘娩出时间、用药至胎儿胎盘娩出时间)、出血量和不良反应情况,统计引产成功率和不良反应发生率。结果:试验组引产成功率为97.67%,对照组为86.05%,差异有统计学意义(P<0.05)。试验组患者用药至宫缩发动时间、宫缩至胎儿胎盘娩出时间、用药至胎儿胎盘娩出时间、出血量均明显低于对照组,差异均有统计学意义(P<0.05)。试验组患者出现过敏反应2例、恶心呕吐1例、软产道裂伤0例、产后大出血0例,不良反应发生率6.98%;对照组患者出现过敏反应3例、恶心呕吐3例、软产道裂伤0例、产后大出血1例,不良反应发生率16.28%,两组差异无统计学意义(P>0.05)。结论:米非司酮联合米索前列醇在瘢痕子宫中期妊娠引产中具有效果良好、成功率高和安全性好,适合临床长期推广应用。

Objective： To evaluate the efficacy,safety and clinical feasibility of mifepristone combined with misoprostol for induced abortion of cesarean scar pregnancy（ CSP）. Methods： Eighty- six CSP patients were randomly divided into experimental group and control group,43 patients in each group. The patients in control group were treated with mifepristone combined with amniotic cavity injection of rivanol for induced abortion,while the patients in experimental group were treated with mifepristone combined with misoprostol for induced abortion. The induction effects,the induction time（ including the time from medication to start time of uterine contraction,the time from start time of uterine contraction to delivery of fetus and placenta,the time from medication to delivery of fetus and placenta）,the amounts of bleeding and adverse reactions in the two groups were observed; the successful rates of induced abortion and morbidities of adverse reactions in the two groups were calculated. Results： The successful rates of induced abortion in experimental group and control group were 97. 67%and 86. 05%,respectively,there was statistically significant difference（ P 0. 05）. The time from medication to start time of uterine contraction,the time from start time of uterine contraction to delivery of fetus and placenta,the time from medication to delivery of fetus and placenta,the amount of bleeding in experimental group were statistically significantly lower than those in control group（ P 0. 05）. In experimental group,two patients were found with allergic reaction,one patient was found with nausea and vomiting,no one was found with soft birth canal laceration and postpartum hemorrhage,the morbidity of adverse reactions was 6. 98%; in control group,three patients were found with allergic reaction,three patients were found with nausea and vomiting,no one was found with soft birth canal laceration,one patient was found with postpartum hemorrhage,the morbidity of adverse reactions was 16. 28%,there was no statistically significant difference between the two groups（ P 0. 05）. Conclusion： Mifepristone combined with misoprostol has a good effect for induced abortion of CSP,the successful rate and safety are high,which is suitable for long- term clinical popularization and application.