米非司酮配伍米索前列醇不同给药间隔终止8—13周妊娠的临床比较

Clinical Comparison of Misoprostol Following Mifepristone for Termination of 8-13 Weeks of Pregnancy at Different Intervals

目的：比较米非司酮配伍米索前列醇不同给药间隔终止8～13周妊娠的药物流产效果。方法：将北京市西城区妇幼保健院妇产科2012年1月至2015年5月住院，自愿要求药物终止妊娠的的孕8～13周208例孕妇随机分为组1（46例）、组2（49例）、组3（50例）、组4（63例）。各组孕妇顿服米非司酮200mg后，分别于1、12、24、36小时阴道放置米索前列醇0．6mg，观察并随访首次使用米非司酮、米索前列醇到胚胎排出时间及流产效果，流产后2小时及24小时的出血量，流产后出血时间及月经恢复时间，服药后的不良反应，月经复潮后患者的满意度。结果：首次使用米索前列醇到胚胎排出时间、流产成功率组l与其他3组比较差异有统计学意义（P〈0．05），组2、3、4间比较差异无统计学意义（P〉0．05）。首次使用米非司酮到胚胎排出时间4组间两两比较差异均有统计学意义（P〈0．05），随两药间隔时间增加而延长。208例孕妇的药物流产成功率为93．8％（195例），其中完全流产80．0％（156例），不全流产20．0％（39例），失败率6．3％（13例）。流产后2小时、2～24小时的出血量及流产后出血时间、月经恢复时间各组间比较差异无统计学意义。米非司酮与米索前列醇使用间隔时间越长，两药间隔期间发生恶心、呕吐的比例增高，且有统计学差异（P〈0．05）。各组在腹泻、发热等不良反应方面差异无统计学意义（P〉0．05）。在满意度调查方面，非常满意和满意的占86％，不满意者占14％；组4的非常满意和满意度低于其他3组。结论：米非司酮配伍米索前列醇终止8～13周妊娠时，两药间隔缩短至12～24小时，流产效果无减低，总的流产时间较短。

Objective：To compare the efficacy of using misoprostol following mifepristone at different administration intervals in the termination of 8 -13 weeks of pregnancy. Methods：208 cases of 8 -13 weeks pregnant women requesting legal abortion at obstetrics and gynecology department in Beijing Xicheng Women and Children Hospital from January 2012 to May 2015 were enrolled in the study. They were randomly divided into group 1 （46 cases）, group 2 （49 cases）, group 3 （50 cases）, group 4 （63 cases）. After taken mifepristone 200 mg respectively in 1,12,24,36 hours,women of group1 ,group 2 ,group 3 ,and group 4 were placed misoprostol 0.6 mg in vagina respectively. During follow-up and observation period ,the following indexes was recorded ,such as embryonic discharge times at different administration intervals, abortion effect, bleeding of abortion after 2h and 24h, bleeding time after abortion and menstrual recovery time, drug adverse reaction and patient＇s satisfaction degree after menstrual recovery. Results：There was a significant difference of embryonic discharge times between group 1 and the other 3 groups（ P 〈 0.05）, and there was no statistical difference on the embryonic discharge times among group 2, group 3 and group 4 （ P 〉 0.05）. As administration interval time increased, the time between taking mifepristone and embryonic discharge increased, and there were significant differences when the pairwise comparisons were done among the 4 groups（ P 〈 0.05）. In 208 pregnant women, abortion success rate was 93.8% （195 cases）, including complete abortion rate 80. 0% （156 cases）, not complete abortion rate 20.0% （39 cases） and failure rate was 6.3% （13 cases）. There was no significant difference in the amount of bleeding after 2 hours,2 -24 hours after abortion and bleeding time and recovery time among the four groups. As administration interval time increased, the proportion of nausea and vomiting also increased, and the differences among the groups were statistically significant（ P 〈0.05）. There was no significant difference in the adverse reactions such as diarrhea,fever and so on among the 4 groups（P〉0.05）. In the satisfaction degree survey,very satisfied and satisfied accounted for 86%, not satisfied accounted for 14%. Very satisfied and satisfied rates of Group 4 were lower than those of the other 3 groups. Conclusions.When administration intervals are reduced to 12 -24 hours between mifepristone and misoprostol,total abortion time can be shorten without increasing the adverse reactions and reducing abortion effect by using misoprostol following mifepristone to terminate the 8 -13 weeks of gestation.