依沙吖啶联合米非司酮和米索前列醇治疗中期妊娠引产的疗效观察
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摘要
目的探讨乳酸依沙吖啶注射液联合米非司酮片和米索前列醇片治疗中期妊娠引产的临床疗效。方法选取2013年9月—2017年3月安阳市人民医院妇产科收治的中期妊娠引产患者132例为研究对象,将所有患者分为依沙吖啶组(A组,44例)、米非司酮联合米索前列醇组(B组,41例)和依沙吖啶联合米非司酮和米索前列醇组(C组,47例)。A组腹部注射位点采用腰穿针行羊膜腔穿刺,注入乳酸依沙吖啶注射液100 mg。B组口服米非司酮片,50 mg/次,2次/d,连续3 d,第4天阴道后穹窿放置米索前列醇片0.4 mg。C组口服米非司酮片100 mg/次,1 h后采用腰穿针行羊膜腔穿刺,注入乳酸依沙吖啶注射液100 mg,12 h后阴道后穹窿放置米索前列醇片0.4 mg。观察各组患者的引产效果,比较术中及术后情况。结果3组引产成功率比较差异无统计学意义。A、B、C组清宫率分别为36.36%、29.27%、12.77%,C组清宫率明显低于A、B组,3组比较差异具有统计学意义(P<0.05)。C组用药至宫缩时间、引产时间、产后2 h出血量、产后出血天数、胎盘残留率显著低于A、B组,3组比较差异具有统计学意义(P<0.05)。C组1级疼痛程度明显高于A、B组,3、4级疼痛程度明显低于A、B组,3组比较差异具有统计学意义(P<0.05)。3组患者复潮时间、经期持续时间相当,没有统计学差异。结论乳酸依沙吖啶注射液联合米非司酮片和米索前列醇片治疗中期妊娠引产具有较好的临床效果,可降低清宫率和胎盘残留率,缩短用药至宫缩时间、引产时间,减少出现量和出血天数,具有一定临床推广应用价值。
Objective To evaluate the clinical effect of Ethacridine Lactate Injection combined with Mifepristone Tablets and Misoprostol Tablets in treatment of midterm pregnancy induced labor. Methods Patients(132 cases) with midterm pregnancy induced labor in Anyang People's Hospital from September 2013 to March 2017 were divided into ethacridine group(A group, 44 cases), mifepristone combined with misoprostol group(B group, 41 cases), and ethacridine combined with mifepristone and misoprostol group(C group, 47 cases). Patients in A group were lumbar puncture needle underwent amniocentesis in abdominal injection site, and be injected Ethacridine Lactate Injection 100 mg. Patients in B group were po administered with Mifepristone Tablets, 50 mg/time, twice daily, and continuously treated for 3 d. At 4 th day, Misoprostol Tablets 0.4 mg were placed on the posterior fornix vagina. Patients in C group were po administered with Mifepristone Tablets 100 mg/time, then injected Ethacridine Lactate Injection 100 mg, and placed with Misoprostol Tablets 0.4 mg on the posterior fornix vagina after 12 h. After treatment, labor induction were evaluated, and intraoperative and postoperative conditions in three groups were compared. Results There were no significant differences in success rate of induced labor among three groups. The curettage rates in A, B, and C groups were 36.36%, 29.27% and 12.77%, respectively, and the curettage rates in C group were significantly lower than that in A and B groups, and there was difference among three groups(P < 0.05). The time of drug use to uterine contraction, time of induced labor, 2 h postpartum hemorrhage, the number of bleeding days, and placental residual rate in C group were significantly lower than those in A and B groups, and there was difference among three groups(P < 0.05). The grade 1 of pain degree in C group was significantly higher than those in A and B groups, but the grade 3 and 4 of pain degree in C group was significantly lower than those in A and B groups, and there was difference among three groups(P < 0.05). Conclusion Ethacridine Lactate Injection combined with Mifepristone Tablets and Misoprostol Tablets has clinical curative effect in treatment of midterm pregnancy induced labor, can decrease the curettage rate and placental residual rate, shorten the time of drug use to uterine contraction and time of induced labor, reduce the amount of appearance and the number of bleeding days, which has a certain clinical application value.
Objective To evaluate the clinical effect of Ethacridine Lactate Injection combined with Mifepristone Tablets and Misoprostol Tablets in treatment of midterm pregnancy induced labor. Methods Patients(132 cases) with midterm pregnancy induced labor in Anyang People's Hospital from September 2013 to March 2017 were divided into ethacridine group(A group, 44 cases), mifepristone combined with misoprostol group(B group, 41 cases), and ethacridine combined with mifepristone and misoprostol group(C group, 47 cases). Patients in A group were lumbar puncture needle underwent amniocentesis in abdominal injection site, and be injected Ethacridine Lactate Injection 100 mg. Patients in B group were po administered with Mifepristone Tablets, 50 mg/time, twice daily, and continuously treated for 3 d. At 4 th day, Misoprostol Tablets 0.4 mg were placed on the posterior fornix vagina. Patients in C group were po administered with Mifepristone Tablets 100 mg/time, then injected Ethacridine Lactate Injection 100 mg, and placed with Misoprostol Tablets 0.4 mg on the posterior fornix vagina after 12 h. After treatment, labor induction were evaluated, and intraoperative and postoperative conditions in three groups were compared. Results There were no significant differences in success rate of induced labor among three groups. The curettage rates in A, B, and C groups were 36.36%, 29.27% and 12.77%, respectively, and the curettage rates in C group were significantly lower than that in A and B groups, and there was difference among three groups(P < 0.05). The time of drug use to uterine contraction, time of induced labor, 2 h postpartum hemorrhage, the number of bleeding days, and placental residual rate in C group were significantly lower than those in A and B groups, and there was difference among three groups(P < 0.05). The grade 1 of pain degree in C group was significantly higher than those in A and B groups, but the grade 3 and 4 of pain degree in C group was significantly lower than those in A and B groups, and there was difference among three groups(P < 0.05). Conclusion Ethacridine Lactate Injection combined with Mifepristone Tablets and Misoprostol Tablets has clinical curative effect in treatment of midterm pregnancy induced labor, can decrease the curettage rate and placental residual rate, shorten the time of drug use to uterine contraction and time of induced labor, reduce the amount of appearance and the number of bleeding days, which has a certain clinical application value.
引文
[1]李佳.米非司酮联合利凡诺在中期妊娠期引产中的应用价值分析[J].当代医学,2017,23(8):49-51.
[2]刘冬,阮洁,黄薇.依沙吖啶用于瘢痕子宫中期引产的安全性研究[J].中国妇产科临床杂志,2012,13(2):104-107.
[3]李隆敏,高婉丽,陈淑平,等.米非司酮配伍米索前列醇用于晚期妊娠引产的效果观察[J].中华妇产科杂志,1996,31(11):681-684.
[4]赵新春.米索前列醇联合米非司酮治疗妊娠10~16周稽留流产的疗效及安全性分析[J].药物评价研究,2015,38(6):668-671.
[5]曹泽毅.中华妇产科学[M].下册.北京:人民卫生出版社,1999:2595-2601.
[6]陈金星,魏青,夏云,等.自控硬膜外分娩镇痛对产程和分娩方式的影响[J].国际麻醉学与复苏杂志,2012,33(12):811-813,852.
[7]马玉燕.中期妊娠引产的适应证及方法选择[J].中国实用妇科与产科杂志,2002,18(5):259-260.
[8]刘长新.依沙吖啶羊膜腔内穿刺用于瘢痕子宫妊娠17~27周引产的临床观察[J].北京医学,2009,31(5):299-300.
[9]Peng P,Liu X Y,Li L.Clinical analyses of 66 cases of mid-trimester pregnancy termination in women with prior cesarean[J].J Chin Med J,2015,128(4):450-454.
[10]Kanat-Pektas M.Response to“The first-line approach for cesarean scar pregnancy:The most adopted being not the best”[J].Taiwan J Obstet Gynecol,2016,55(5):764-765.
[11]王丽珍.用米非司酮联合米索前列醇对中期妊娠的女性进行引产的效果观察[J].当代医药论丛,2017,15(3):110-111.
[12]Davenport M,Delgado G,Harrison M P,et al.Embryo survival after mifepristone:A systematic review of the literature[J].Issues Law Med,2017,32(1):3-18.
[13]Wu H L,Marwah S,Wang P,et al.Misoprostol for medical treatment of missed abortion:a systematic review and network meta-analysis[J].Sci Rep.2017,7(1):1664.
[14]Sharma N,Das R,Ahanthem S S.Misoprostol induced convulsion-a rare side effect of misoprostol[J].J Clin Diagn Res,2017,11(2):QD01-QD02.
[15]龚玲英,江松涛.利凡诺配伍米非司酮、米索前列醇终止中期妊娠引产的临床观察[J].现代诊断与治疗,2012,23(5):550-551.
[16]Chen C,Lin F,Wang X,et al.Mifepristone combined with ethacridine lactate for the second-trimester pregnancy termination in women with placenta previa and/or prior cesarean deliveries[J].Arch Gynecol Obstet,2017,295(1):119-124.
[2]刘冬,阮洁,黄薇.依沙吖啶用于瘢痕子宫中期引产的安全性研究[J].中国妇产科临床杂志,2012,13(2):104-107.
[3]李隆敏,高婉丽,陈淑平,等.米非司酮配伍米索前列醇用于晚期妊娠引产的效果观察[J].中华妇产科杂志,1996,31(11):681-684.
[4]赵新春.米索前列醇联合米非司酮治疗妊娠10~16周稽留流产的疗效及安全性分析[J].药物评价研究,2015,38(6):668-671.
[5]曹泽毅.中华妇产科学[M].下册.北京:人民卫生出版社,1999:2595-2601.
[6]陈金星,魏青,夏云,等.自控硬膜外分娩镇痛对产程和分娩方式的影响[J].国际麻醉学与复苏杂志,2012,33(12):811-813,852.
[7]马玉燕.中期妊娠引产的适应证及方法选择[J].中国实用妇科与产科杂志,2002,18(5):259-260.
[8]刘长新.依沙吖啶羊膜腔内穿刺用于瘢痕子宫妊娠17~27周引产的临床观察[J].北京医学,2009,31(5):299-300.
[9]Peng P,Liu X Y,Li L.Clinical analyses of 66 cases of mid-trimester pregnancy termination in women with prior cesarean[J].J Chin Med J,2015,128(4):450-454.
[10]Kanat-Pektas M.Response to“The first-line approach for cesarean scar pregnancy:The most adopted being not the best”[J].Taiwan J Obstet Gynecol,2016,55(5):764-765.
[11]王丽珍.用米非司酮联合米索前列醇对中期妊娠的女性进行引产的效果观察[J].当代医药论丛,2017,15(3):110-111.
[12]Davenport M,Delgado G,Harrison M P,et al.Embryo survival after mifepristone:A systematic review of the literature[J].Issues Law Med,2017,32(1):3-18.
[13]Wu H L,Marwah S,Wang P,et al.Misoprostol for medical treatment of missed abortion:a systematic review and network meta-analysis[J].Sci Rep.2017,7(1):1664.
[14]Sharma N,Das R,Ahanthem S S.Misoprostol induced convulsion-a rare side effect of misoprostol[J].J Clin Diagn Res,2017,11(2):QD01-QD02.
[15]龚玲英,江松涛.利凡诺配伍米非司酮、米索前列醇终止中期妊娠引产的临床观察[J].现代诊断与治疗,2012,23(5):550-551.
[16]Chen C,Lin F,Wang X,et al.Mifepristone combined with ethacridine lactate for the second-trimester pregnancy termination in women with placenta previa and/or prior cesarean deliveries[J].Arch Gynecol Obstet,2017,295(1):119-124.