戊酸雌二醇联合常规药物治疗稽留流产的临床疗效

Efficacy of Estradiol Valerate Combined with Conventional Treatment on Patients with Missed Abortion

目的观察戊酸雌二醇联合常规药物治疗稽留流产患者的临床疗效。方法选取2015年1月至2018年1月扬州市中医院和扬州友好医院收治的86例稽留流产患者为研究对象,按照随机数字法分为观察组和对照组,各43例。对照组给予米非司酮片口服50 mg,每日2次,于治疗第3天阴道后穹窿置入400μg米索前列醇;观察组在对照组治疗的基础上给予戊酸雌二醇口服5 mg,每日2次。观察两组患者的妊娠组织排除率、妊娠组织排除时间、宫颈扩张满意度和清宫手术时间、出血量、术后出血时间,清宫后复查彩色多普勒超声查看有无残留,记录发生的并发症。结果观察组妊娠组织排除率显著高于对照组[86. 0%(37/43)比58. 1%(25/43)],妊娠组织排除时间显著短于对照组[(3. 8±0. 7) h比(5. 5±1. 1) h],宫颈扩张满意度高于对照组[88. 4%(38/43)比55. 8%(24/43)](P <0. 01);观察组清宫手术时间短于对照组[(6. 2±1. 4) min比(10. 9±3. 3) min]、出血量低于对照组[(32±5) m L比(39±7) m L]、术后出血时间短于对照组[(3. 9±1. 0) d比(5. 2±1. 4) d](P <0. 01);观察组第1次清宫后残留率及并发症发生率均低于对照组[0. 0%(0/43)比20. 9%(9/43),2. 3%(1/43)比16. 3%(7/43)](P <0. 05)。结论戊酸雌二醇联合常规药物治疗稽留流产可明显改善妊娠组织排除率、妊娠组织排除时间以及宫颈扩张满意度,降低患者清宫手术时间、出血量及术后出血时间,并且可降低清宫后残留率和并发症的发生率。

Objective To observe the clinical efficacy of estradiol valerate combined with conventional drugs in the treatment of missed abortion. Methods A total of 86 cases of missed abortion admitted to Yangzhou Hospital of Traditional Chinese Medicine and Yangzhou Friendship Hospital from Jan. 2015 to Jan. 2018 were included in the study.According to the random number method,the patients were randomly divided into an observation group（ n =43） and a control group（ n =43）. The control group was treated with mifepristone tablets,50 mg/time orally,2 times per day,and on the 3rd day of treatment,the 400 μg misoprostol was placed into the posterior vaginal fornix; the observation group was added with estradiol valerate orally 5 mg/time,2 times/d.The pregnancy tissue exclusion rate,pregnancy tissue exclusion time, cervical dilatation satisfaction and clearance operation time,bleeding volume, bleeding time after operation,residues checked by color Doppler ultrasound after clearance of the two groups were observed,and complications were recorded. Results The exclusion rate of pregnancy tissue in the observation group was significantly higher than that in the control group[86.0%（37/43） vs 58.1%（25/43）],the time of pregnancy tissue exclusion was significantly shorter than that in the control group [（3.8±0.7） h vs （5.5±1.1） h], the satisfaction degree of cervical dilatation was higher than that in the control group[88.4%（38/43） vs 55.8%（24/43）]（ P 〈0.01）. The operation time of uterine clearance in the observation group was shorter than that in the control group[（6.2±1.4） min vs （10.9±3.3） min], and the blood loss in the observation group was less than that in the control group[（32±5） mL vs （39±7） mL], postoperative bleeding time was shorter than that in the control group[（3.9±1.0） d vs （5.2±1.4） d]（ P 〈0.01）;the residual rate and complication rate of the observation group were lower than that of the control group[0.0%（0/43） vs 20.9%（9/43）,2.3%（1/43） vs 16.3%（7/43）]（ P 〈0.05）. Conclusion Estradiol valerate combined with routine treatment for missed abortion can significantly improve the removal rate of pregnancy tissue,reduce removal of pregnancy time and cervical expansion satisfaction,reduce the time of curettage,bleeding and postoperative bleeding time,and reduce the postoperative residual rateand the incidence of complications.