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目的分析米非司酮联合应用米索前列醇用于终止早孕的有效性和安全性。方法随机分为A(60例)、B(57例)、C(60例)3组,3组在年龄、孕产次、孕周等方面具有可比性。患者入院后均阴道冲洗1次,A组:第1、2天每8～12小时空腹口服米非司酮50mg,共200mg,第3天将米索前列醇600μg放入阴道后穹窿;B组:第1天空腹顿服米非司酮200mg,第2天置米索前列醇600μg于阴道后穹窿;C组:放置米索前列醇600μg于阴道后穹窿。确诊为早孕者,在医生监护下,米非司酮和米索前列醇序贯使用,有出血或不完全流产时及时进行处理。制定完全流产、不完全流产、失败指标。结果 A、B2组序贯用药完全流产率94.0%(110/117),C组完全流产率为0。A、B2组胎盘剥离及妊娠组织排在宫颈内口或排出阴道者均较C组多(P均<0.05),且术中出血量均较C组少(P均<0.05),手术时间较C组短(P均<0.05)。结论米非司酮和米索前列醇序贯用药,可提高完全流产率。阴道放置米索前列醇避免了首关效应,生物利用度较高,且用药量及副作用明显减少。顿服米非司酮给药能保持稳定的血药浓度,引起大部分蜕膜绒毛变性坏死甚至胎儿死亡软化,用于钳刮术应已满足。
Objective To analyze the efficacy and safety of mifepristone in combination with misoprostol for termination of early pregnancy. The patients were randomly divided into three groups: A (60 cases), B (57 cases) and C (60 cases). The three groups were comparable in terms of age, gestational age and gestational age. Patients were admitted to the hospital after vaginal washing 1, Group A: 1,2 days every 8 to 12 hours fasting oral mifepristone 50mg, a total of 200mg, the first three days of misoprostol 600μg into the vaginal fornix; Group B : The first day of fasting Dayton mifepristone 200mg, the second day of misoprostol 600μg in the vaginal fornix; C group: place misoprostol 600μg in the vaginal fornix. The diagnosis of early pregnancy, under the supervision of a doctor, mifepristone and misoprostol sequential use, bleeding or incomplete abortion, timely treatment. Make a complete abortion, incomplete abortion, failure indicators. Results The complete abortion rate was 94.0% (110/117) in group A and group B2, and the rate of complete abortion in group C was 0. The placental detachment and pregnancy in A and B2 groups were more than those in C group (all P <0.05), and the amount of bleeding in operation was less than that in C group (all P <0.05). The operative time C group was shorter (P <0.05). Conclusion The sequential use of mifepristone and misoprostol can improve the complete abortion rate. Vaginal misoprostol to avoid the first pass effect, high bioavailability, and medication and side effects significantly reduced. Dayton dose of mifepristone administration can maintain a stable plasma concentration, causing most of the decidual degeneration and necrosis degeneration or fetal death softening for forceps curettage should have been met.