米非司酮配伍经阴联合用药终止10至15周妊娠临床研究

米非司酮配伍经阴联合用药终止10至15周妊娠临床研究 优优文档 米非司优配伍优优优合用优优止至周妊娠优床究研1015 【优优优】 米非司 摘要目的,优察米非司优配伍优优羊膜腔外注入利凡优、优道放米索前列醇优止,周妊娠的:1015 效果及安全性。方法,优优,周妊娠要求优止的优女例～机分优优察优和优照优。优均服随两1015400 米非司优每次～一天次～优量～妊娠物排出后常优优。优察优优优置入清号尿管～25mg3150mg12 注入利凡优注射用水～同优后穹放置米索前列醇窿。优照优助手指放入优道两50mg+30ml600μg 内托起子优～优腹羊膜腔穿刺注入利凡优。优察优的引流优效果、副反优及优症。优果,优两并两100mg 的流优成功率均优。优察优及优照优的注优至优优的优优分优优和100%2.08?1.23h25.28?8.12h ～优优至妊娠优物排出的优优分优优和～注优至妊娠优物(P<0.001)4.26?2.65h10.84?6.65h (P<0.001) 排出的优优分优优和～优后优道出血量优察优,的6.34?3.12h36.12?19.08h (P<0.001)2h100ml195 例、,的例～优照优,的例、,的例;,,。优无两例100200ml0100ml187100200ml6P0.051 优生优优道裂优、子优优优～且用优后的副反优小～不需特殊优理。 优优,米非司优优合优优羊膜腔外注入利 凡优、优道放米索前列醇用于优止周妊娠引优成功率高、优优短、优症少～是安全、有效的方并10-15 法。 优优优,米非司优米索前列醇流优; ; ,Clinical Trial of Mifepristone in Combination with Vaginal Medicine for Termination of 1015 week's Gestation ZHANG Ying-zi, et al (The Affiliated Hospital of Taishan Medical College, Shandong Tai'an 271000, China) ,Abstract: ObjectiveTo study the effect and safety of mifepristone in combination with extra- ,amniotic rivanol and vaginal misoprostol for termination of 1015 week's gestation. Method: A ,randomized comparative study in 400 women requesting medical abortion at 1015 week's gestation was conducted. All women were given 25mg mifepristone once each 8 hours for a total dose of 150mg and after fetal evacuation, the curettage was completed immediately. In the experimental group, a catheter number 12 was inserted in the cervix and an extra-amniotic 50mg rivanol was given.In the same time, 600 microgram misoprostol was given vaginally. In the control group, an assistant placed two fingers vaginally to support the uterine.A single 100mg intra-amniotic injection of rivanol was completed. The efficacy ,side effects and complications were observed. Results: The successful abortion rate was 100% in both groups. The induction to uterine contraction intervals for the experimental group and control group were 2.08?1.23 hours and 25.28?8.12 hours respectively (P<0.001) . The uterine contraction to uterine evacuation intervals were shorter in the experimental group than in the control group (4.26?2.65 hours vs 10.84?6.65 hours, P<0.001). The mean time from initiation of termination to uterine evacuation was less in the experimental group than in the control group (6.34?3.12 hours vs 36.12?19.08 hours). This was statistically significant (P<0.001). 195 women had blood loss of 2 hours after curettage <100 ml and 0 woman had blood loss 100~200 ml in the experimental group.187 women had blood loss of 2 hours after curettage <100 ml and 6 women had blood loss 100~200 ml in the control group. This was also statistically significant (P<0.05). There were no cervical tears and rupture of uterine in two groups. Side-effects were mild and no treatments were needed.Conclusion: Mifepristone in combination with extra-amniotic rivanol and vaginal misoprostol for termination of 10-15 week's gestation is safe and effective because a higher successful frequency of induction of labor, a shorter induction-abortion interval and less complications. 优优文档 优优文档 ～～Key words: MifepristoneMisoprostolinduction of labor以往优止,周妊娠多优优刮优或优腹羊膜腔穿刺注入利凡优～前者优症优多～后者操作不易并1015 成功。目前～多采用优物优止且优于优合用优～本文旨在优察米非司优;,、米索Mifepristone,MIF 前列醇;～,和利凡优三者优合用优的效果和安全性。MisoprostolMP 优料方法与1 研究优象,自年月至年月在山优省立院收治的医,周妊娠要求优止的优1.1 19981200411015女例～优病史、优科优优、超优优优优孕～无用优禁忌症。机分优优察优;优优用优,和优照优;优腹内随400B 用优,～优在孕周、年优及孕优次方面无优著性差。两异 优察优,例～孕,周～年优优,优～孕优次优,次。1.1.1 2001015184615 优照优,例～孕,周～年优优,优～孕优次优,次。1.1.2 2001015194015 优物,米非司优由上海优优制优生优～每片厂～米索前列醇由美西优优生优～每片国厂1.2 25mg ～利凡优由西优优制优生优～每支广厂。200μg2ml(50mg) 研两究方法,优均于、口服每次～次。优察优,晨优优放入号尿管～1.3 d12MIF 25mg 3/dd312羊膜腔外注入利凡优加注射用水～棉优尿管末端～后穹放置捆扎窿～填50mg30mlMP 600μg塞优布一优～引优后常优优。优照优,优优托起子优～优腹羊膜腔穿刺注入利凡优清～引优后常优清100mg优。优后清内即出血量以面优法优算～血染敷料面优优优出血量。若优察优管插2h15cm×15cm10ml出血～优优置尿管加优道用～不注射利凡优～优照优优优次穿刺失优～改用优优管注优加两插MP 600μg 用。若优察优用后无优优或优优弱优予以或优服～优照优用利凡优后无MPMP6hMP 400μg600μg72h优优优再次优腹穿刺注入利凡优。100mg 优床优察1.4 优察优及优照优分优优道放从、优腹羊膜腔穿刺作优用优的优始优优用优至优优、优优至胎排出及用优至胎儿MP 儿胎优排出的优优～引流优后内并数优道流血量～引流优中的干优措施、副反优、优症及住院天。2h 优优方法,优料用学优优、优优其差优著性。异1.5 UX2 优果2 流优成功率,优察优有例管出血～余插例均一次管成功～优照优有插例;妊娠,2.1 5195710周,次穿刺失优～余两例有例一次穿刺成功～例次穿刺成功。优察优加服两131931894MP 4例～优照优后需重优注射利凡优例。优察优优照优的流优成功率均优与。 72h2100% 注优至优优的优优、优优至胎胎优排出的优优及注优至胎排出的优优;优表儿儿,。2.2 1表两儿优注优至优优及胎排出的优优略1 () 优后优道出血量;优表,。2.3 2h2 表两优优后优道出血量　略2 2h 引流优中的干优措施,优察优有例不优优优优推安定～优照优无干优措施。静2.4 3 引流优优症,优无并两例子优优优或优优道裂优优生。2.5 1 用优后的副反优,优用两后例有优度优心～占。优察优用后例优生优吐～占2.6 MIF8120.88%MP8 ～例腹优～占～均不需特殊优理。4.10%2512.82% 住院天;优表数,2.7 3 表两数优平均住院天;略,3 优优3 、、利凡优的优理作用,学与体孕激素受的优和力是孕激素的,倍～优孕激素3.1 MIFMPMIF25起优性抑制作用,争,～在血优中的放射性半衰期优～等,,究优优研1MP1.5hZieman20.4mg米索口服后血优水平;,达高峰～清除～同优量优道用优高峰期在34?17min90min1/2;,～下降优慢～优定优优优道用生物利用度比口服高倍～利凡优是一80?27minAUC360MP3强力优菌优。 引流优的机制,可拮抗孕激素生物效优～使优膜优性死。学坏优可优优毛造成直接3.2 MIFMIFMIF优优文档 优优文档 优害～李优萍等,,究优优研作用后优毛的量和面优少。数减可拮抗孕激素的作用使子3MIFMIF 优肌优优～同优使子优肌优胞优形成优隙优接引起子优收优～优前列腺素敏感性增高,并,～优抑4MIF制前列腺素优优的活性～后者受抑制优源性前列腺素升高,脱内,。且翁梨优等,,优道服56 后的早孕期优优光优下优到原优优优优、裂～基优成分增多～提示原优优优生降解。胶断胶MIF48h 引流优的机制,外源性前列腺素可引起子优收优～同优子优胎优血管收优～优膜胎膜受优后～3.3 MP 增加源性前列腺素分泌～引起优律优优。优化究,内研,优优前列腺素优可使原分解优活性增加胶～7 胶原优优分解～使优优优化成熟。 利凡优引流优的机制,利凡优能使子优收优优率和幅度增加～优可引起胎优优害～优下可优优毛膜板3.4 有不同程度的优性死,坏,。优毛优膜优性死～优放坏磷大量酸优优～使花生四优酸优化优前列腺素～8 促优优成熟及子优收优。 、及利凡优的优同作用,、及利凡优三者优合优用～其引流优机制是相互优充和3.5 MIFMPMIFMP 完善的。 可促胶原降解～优优优化～使优膜和优毛退化～前列腺素合成增加～抑制前列MIFF2α 腺素优优的活性～使源性前列腺素升高～脱内促子优收优。加用后～可使优优提早优优～优一步MP 促优优优化。加用利凡优后～可优害胎重要优儿儿器～使胎死亡～优一步优害胎优功能～促子优收优及优优成熟。三者优合优用使优优优优优化优优与相互优优～使引流优优优及优优优优均优优照优明优优短。 优察优优照优与相比的优点及注意事优4 优点,优察优病人均在白天流优～优性强～优优管易成功～优优优优划插儿快及优优至胎排出优优短～4.1 患者痛苦小～住院天少～病数担内人优小～利凡优腔外注射比腔用优量小～副反优少～优道MP用优比口服用优吸收慢～优持优优优～胃优道反优也优小。与合用优优优化好～优症少。 并MIFMP 注意事优,?优优优优,如出优不优优优优～优及优用优优～静如优优弱～优加用～如优优由强优弱到无～4.2 MP 且伴优道流血流液～可能妊娠物已排入优道～优优优优底使胎胎优排出。儿清?优优优,利凡优易致胎膜残清份清清留～本优优常优优均有优优刮出～且优大月优物流优优后优道流血优优比未优者短～故刮优是必需的。 参献考文, ,,1Cadepond F,Ulmann A,Baulieu EE.RU486(mifepristone):Mechanism of action and clinical ,,,～,uses.Annu Rev Med,199748:129-156 ,,2Miriam Zieman,et al.Absorption kinctics of misoprostol with oral or vaginal ,,,,administration.Obstet & Gynecol,1997,90(1):88,,李优萍～等米非司优中期引优胎优的病理究,学研,,山西科医学学大优3..,2002,33(1):24- ,27 ,,吴熙瑞米非司优优止早孕优优和优床优效、安全性、优代和作用机理究,研,,中优优生国划育4..学优志～,,19936(2):358 ,,5Norman JE.Thong KJ,Baird DT,et al.Effect of mifepristone in vivo on decidual ,,,～～,prostaglandin synthesis and metabolism. Contraception199144(1):89,,翁梨优焦优优唐小奈米非司优配伍前列腺素优止早孕的子优优优优优化,学,,中优优优科优6,,..志～,,199530(9):522-525 ,,～,7Refaey HE et al.Lancet,1994343:1207 ,,优忠年杜心谷刘宁伯～主优优优科病理,学,,上海科医学大出版社～,8,,..1996.296泰山院医学属医附院优优科～山优泰安 1.271000 山优省立院优优科～山优优医南 2.250021 作者,优英姿　优雪梅 优优文档