米非司酮片的不同用法在瘢痕子宫妊娠无痛人流中的临床观察

Clinical observation of mifepristone tablets by different usage for painless artificial abortion in scarred uterus pregnancy

目的探讨米非司酮片的不同用法在瘢痕子宫妊娠无痛人工流产(人流)中的临床作用。方法 960例瘢痕子宫早孕要求无痛人流孕妇作为研究对象,将其随机分为A、B、C组,每组320例,A组收入院后手术前2 d每天口服米非司酮50 mg,2次/d;B组手术前1 d晚饭后2 h顿服米非司酮150 mg;C组不使用米非司酮;三组患者均于术前配伍米索前列醇。比较三组的宫颈软化且无需扩张情况、术前出血、手术时间、术中出血、并发症发生情况。结果术前出血发生率比较,A组6.3%(20/320)、C组3.1%(10/320)明显低于B组87.5%(280/320),差异有统计学意义(P<0.05),A组稍高于C组,差异无统计学意义(P>0.05)。A组宫颈软化且无需扩张率为95.6%(306/320)与B组的96.3%(308/320)比较差异无统计学意义(P>0.05),A、B组宫颈软化且无需扩张率均明显高于C组的19.1%(61/320),差异具有统计学意义(P<0.05)。A组宫颈粘连等并发症发生率为3.1%(10/320),B组为2.5%(8/320),C组为4.7%(15/320),三组宫颈粘连等并发症发生率比较差异无统计学意义(P>0.05)。结论手术前1 d晚饭后2 h顿服米非司酮与后手术前2 d口服米非司酮分别配伍米索前列醇在瘢痕子宫无痛人流中软化宫颈、减少术中出血及并发症方面无明显差异,后者因术前出血机会增加,反而不利于手术,前者用于瘢痕子宫无痛人流值得借鉴。

Objective To investigate clinical effect by mifepristone tablets by different usage for painless artificial abortion in scarred uterus pregnancy. Methods A total of 960 pregnant women with early scarred uterus pregnancy needing artificial abortion as study subjects were randomly divided into groups A, B and C, with 320 cases in each group. Group A received oral administration of 50 mg mifepristone by 2 times/d in the first 2 d before operation after admission. Group B received 150 mg mifepristone in 2 h after dinner beforeoperation. Group C received no mifepristone. All three groups received preoperative combination of misoprostol.Comparison was made on cervical softening without expansion status, preoperative hemorrhage, operation time,intraoperative hemorrhage, and complications condition in the three groups. Results Comparison of incidenceof preoperative hemorrhage showed obviously lower incidence in group A as 6.3% (20/320) and group C as 3.1%(10/320) than 87.5% (280/320) in group B, and their difference had statistical significance (P<0.05). Group A hadslightly higher incidence than group C, while their difference had no statistical significance (P>0.05). Comparingwith 96.3% (308/320) in group B, group A had cervical softening without expansion rate as 95.6% (306/320), andtheir difference had no statistical significance (P>0.05). Both groups A and B had much higher cervical softeningwithout expansion rate than 19.1% (61/320) in group C, and the difference had statistical significance (P<0.05).Incidence of cervical adhesion as complications was respectively 3.1% (10/320) in group A, 2.5% (8/320) ingroup B and 4.7% (15/320) in group C. There was no statistically significant difference of incidence of cervical adhesion as complications across the three groups (P>0.05). Conclusion Administration of mifepristone, combing with misoprostol, in 2 h after dinner before operation and in the first 2 d before operation after admission shows no obvious difference in cervical softening, intraoperative hemorrhage and complications reducing for painless artificial abortion in scarred uterus pregnancy. The latter is not beneficial for operation due to its increasing preoperative hemorrhage chances. The former is worth referring for painless artificial abortion in scarred uterus pregnancy.