超声引导侧卧位注射利凡诺联合米索前列醇在未成年中期妊娠引产中的运用

The application of ultrasound guided in lateral recumbent position injection of rivanol combined with misoprostol on induction of labor in midterm pregnancy

目的:探讨中期妊娠行超声定位引导羊膜腔穿刺,转侧卧位注入乳酸依沙吖啶注射液(利凡诺),联合阴道后穹窿放置米索前列醇引产的临床运用效果。方法:选取2010年1月—2016年6月18岁以下孕13~20周待引产的意外妊娠患者110例,按随机数字法分为观察组和对照组,每组55例。观察组超声引导定位,仰卧位羊膜腔穿刺后改成侧卧位,羊水自然流出或轻松抽吸出羊水后注入利凡诺50 mg,注射后立即将米索前列醇200μg置于阴道后穹窿。对照组常规仰卧羊膜腔穿刺注射利凡诺100 mg。统计两组羊膜腔穿刺成功率、终止妊娠时间、出血量、残留物等。结果:观察组55例均一次穿刺并于48 h内引产成功,无一例出现需处理的并发症。对照组一次穿刺成功率仅56.36%。观察组终止妊娠时间、出血量、残留物等与对照组比较,差异均有统计学意义(P<0.01)。结论:超声引导定位羊膜腔穿刺后转侧卧位注射利凡诺,减少了重复穿刺引发的感染和出血,引产穿刺成功率高。联合阴道后穹窿放置米索前列醇,能促进宫颈成熟软化,明显缩短产程,减轻产妇疼痛,避免宫颈撕裂及大出血的可能。

Objective： To observe the clinical effects of ultrasound guided percutaneous puncture of the amniotic cavity for the mid pregnancy,after the patients turn into a lateral position,the ethacridine lactate injection（ Rivanol） was injected into the amniotic cavity,combined with vaginal fornix Misoprostol induced labor.Methods： Select from January 2010 to June 2016,13 to 20 weeks of pregnancy to prepare for the induction of labor in the minor unintended pregnancy 110 cases as the research object,they are divided into two groups by random numbers.The observation group was guided by ultrasound,the supine underwent amniocentesis and then into a lateral position,the amniotic fluid from the needle core automatic outflow or amniotic fluid can easily after suction,and then injected rivanol 50 mg.After injection,immediately misoprostol 200 μg placed in the posterior fornix of vagina.The control group routine supine amniocentesis injection of rivanol 100 mg.Two groups of amniotic cavity puncture success rate,termination of pregnancy time,blood loss,residues and other projects for statistical.Results： In the observation group,55 cases were successfully performed in 48 hours,there were no complications requiring treatment.The success rate of the first puncture in the control group was only 56.36%.There were significant differences between the observation group and the time of termination of pregnancy,the amount of bleeding,and the residue（ P〈0.01）.Conclusion： Ultrasound guided percutaneous puncture of the amniotic cavity,contralateral supine injection of rivanol,reduction of infection and bleeding caused by repeated puncture,can get a higher success rate of induced abortion.In the posterior vaginal fornix misoprostol placement,can promote cervical ripening and softening,obviously shorten the labor process,reduce maternal pain,to avoid the possibility of cervical tear and bleeding.