米非司酮预处理对瘢痕妊娠宫腹腔镜联合治疗术后患者应激反应和性激素水平的影响

Effects of mifepristone pretreatment on stress response and sex hormones levels in patients with scar pregnancy after hysteroscopy-laparoscopy combined treatment

目的 探究米非司酮预处理对瘢痕妊娠宫腹腔镜联合治疗术后患者应激反应和性激素水平的影响。方法 选取2018年3月至2021年3月安康市妇幼保健院收治的114例剖宫产后瘢痕妊娠(CSP)患者为研究对象,按随机数表法分为观察组(n=58)和对照组(n=56)。观察组患者在宫腹腔镜联合术治疗前口服米非司酮预处理,对照组患者直接行宫腹腔镜联合术。比较两组患者的疗效、术中出血量、住院时间、血β-人绒毛膜促性腺激素(β-h CG)恢复正常时间、术后血清C反应蛋白(CRP)、皮质醇(COR)、β-hCG、孕酮(P)、黄体生成素(LH)和卵泡刺激素(FSH)水平。结果 术后1个月,观察组患者的治疗有效率为96.55%,明显高于对照组的83.93%,差异有统计学意义(P<0.05)。观察组患者术中出血量为(28.17±3.58) m L,明显少于对照组的(43.29±5.37) m L;住院时间为(8.46±1.57) d,明显长于对照组的(4.53±1.02) d;术后β-h CG恢复正常时间为(18.57±2.16) d,短于对照组的(23.64±3.85) d,差异均有统计学意义(P<0.05)。观察组患者术后24 h的血清CRP、COR水平分别为(6.82±1.43) mg/L、(19.05±4.13) mg/L,明显低于对照组的(8.92±1.57) mg/L、(23.78±4.26) mg/L,差异均有统计学意义(P<0.05);术后1周,观察组患者的血清β-h CG、P、LH、FSH水平分别为(1 164.09±52.31) IU/L、(8.54±2.06) mmol/L、(10.42±1.65)μg/L、(10.72±1.65)μg/L,明显低于对照组的(1 287.36±54.32) IU/L、(10.78±2.39) mmol/L、(15.08±1.37)μg/L、(15.08±1.34)μg/L,差异均有统计学意义(P<0.05)。结论 米非司酮预处理治疗瘢痕妊娠,可提高宫腹腔镜联合术的疗效,减少术中出血量,降低患者术后应激反应及性激素水平。

Objective To explore the effects of mifepristone pretreatment on stress response and sex hormones levels in patients with scar pregnancy after hysteroscopy-laparoscopy combined treatment. Methods A total of 114 patients with cesarean scar pregnancy(CSP) admitted to Ankang Maternal and Child Health Care Hospital between March2018 and March 2021 were selected as the study subjects and were divided into observation group(n=58) and control group(n=56) by random number table method. The observation group was pretreated with oral mifepristone before hysteroscopy-laparoscopy combined treatment, and the control group underwent hysteroscopy-laparoscopy combined treatment directly. The efficacy, intraoperative blood loss, length of hospital stay, normal recovery time of blood β-human chorionic gonadotropin(β-h CG), and levels of serum C-reactive protein(CRP), cortisol(COR), β-h CG, progesterone(P),luteinizing hormone(LH), and follicle stimulating hormone(FSH) after surgery were compared between the two groups.Results At 1 month after surgery, the effective rate of treatment was 96.55% in the observation group, significantly higher than 83.93% in the control group(P<0.05). The intraoperative blood loss was(28.17±3.58) m L in the observation group, significantly less than(43.29±5.37) mL in the control group;the length of hospital stay was(8.46±1.57) d, significantly longer than(4.53±1.02) d in the control group;and the normal recovery time of postoperative β-h CG was(18.57±2.16) d, significantly shorter than(23.64±3.85) d in the control group;the differences were statistically significant(P<0.05). The levels of serum CRP and COR were(6.82±1.43) mg/L and(19.05±4.13) mg/L in the observation group at 24 h after surgery, significantly lower than(8.92±1.57) mg/L and(23.78±4.26) mg/L in the control group(P<0.05). At 1 week after surgery, the levels of serum β-h CG, P, LH, and FSH were(1 164.09±52.31) IU/L,(8.54±2.06) mmol/L,(10.42±1.65) μg/L,and(10.72±1.65) μg/L in the observation group, which were significantly lower than(1 287.36±54.32) IU/L,(10.78±2.39) mmol/L,(15.08±1.37) μg/L, and(15.08±1.34) μg/L in the control group(P<0.05). Conclusion Mifepristone pretreatment for scar pregnancy can improve the efficacy of combined hysteroscopy-laparoscopy, reduce the intraoperative blood loss, and lower the postoperative stress response and sex hormones levels.