关于米非司酮配伍米索前列醇终止妊娠10-14周86例临床观察

目的:探讨来非司嗣配伍米索前列醇终止妊娠的临床应用效果,减少流产并发症.方法:将138例.自愿要求终止10-14周妊娠的健康妇女分为两组,钳刮组52例,术前前1天宫颈管内插入导尿管,次日行刮人流术;药流组86例,口服米非司酮50mg共3次,第3天口服米索前列醇0.6mg.比较两种方法的效果.结果:药漉组在流产中及流产后阴道流血及持续时间、子宫体压痛、感染均少于错刮姐(P<0.05),而子宫复旧、月经复潮及月经规则要早于钳刮组.结论:分次口服米非司酮配伍米索前列醇是目前最佳的终止10-14周妊娠的流产方式.     

米非司酮配伍米索前列醇终止不同孕周中期妊娠的效果观察

目的探讨米非司酮配伍米索前列醇终止不同孕周中期妊娠(12～16周、17～28周)的效果及安全性。方法将符合条件药物终止妊娠的妇女200例,根据孕龄分成两组,均口服米非司酮150mg,阴道放置米索前列醇400～800μg。结果两组引产成功率分别为99%和97%,孕周小,引产时间短,不全流产率高;孕周大引产时间长,不全流产率低。结论口服米非司酮配伍阴道放置米索前列醇终止不同孕周中期妊娠具有安全、成功率高,值得推广。     

米非司酮配伍米索前列醇用于早孕流产100例临床观察

目的:了解米非司酮配伍米索前列醇用于早孕流产的临床效果,便于今后在临床继续开展使用.方法:对100例B超检查确诊为宫内妊娠的病人进行服药观察.结果:100例服药病人中,完全流产94例,占94%,不全流产5例,占5%,失败1例,占1%.结论:米非司酮配伍米索前列醇使用早孕流产是-种比较理想的药物流产方法,具有疗效高,使用方便,副作用小,痛苦轻,损伤小的优点.     

米非司酮配伍米索前列醇药物流产不同方法的效果比较

目的:米非司酮配伍米索前列醇药物流产的方法,以提高药物流产的药物流产率.方法:将自愿药物流产的患者随机分为试验组和对照组.试验组:米非司酮25mg bid,用3天,第4天晨06:00顿服米索600μg,10:00加服米索600μg;对照组:米非司酮25mg bid,用3天,第4天晨顿服米索600μg.结果:试验组完全流产率98.2%,显著高于对照组89.5%(P<0.05).试验组阴道流血时间平均(7.8±2.6)天,显著短于对照组(13.2±3.3)天(P<0.05).试验组阴道出血量显著少于对照组(P<0.01);结论米索前列醇常规用药4h后,加服600μg米索前列醇,可提高完全流产率,缩短胚囊排除时间和阴道流血时间,不加重副反应,不影响月经复潮,值得推荐.     

米非司酮联合米索前列醇口服配伍卡孕栓阴道用药对瘢痕子宫妊娠16周内孕妇的引产效果观察

目的探讨米非司酮联合米索前列醇口服配伍卡孕栓阴道用药对瘢痕子宫妊娠16周内孕妇的引产效果。方法选取2017-01—2018-06间兰考第一医院收治的52例瘢痕子宫妊娠16周内的孕妇,均要求引产并有引产指征。随机分为2组,各26例。对照组采用米非司酮联合米索前列醇口服引产,观察组在对照组基础上配伍卡孕栓阴道用药引产。结果观察组成功引产25例(96.15%),急诊B超引导下清宫1例;对照组分别为24例(92.31%)和2例。2组差异无统计学意义(P0.05)。观察组引产时间、引产中出血量及术后住院时间、月经恢复时间均少于或短于对照组,差异均有统计学意义(P0.05)。结论对瘢痕子宫妊娠16周内的孕妇,采取米非司酮联合米索前列醇口服配伍卡孕栓阴道用药引产,成功率高、引产时间少、出血量小、住院时间短,有利于术后恢复。     

补佳乐在稽留流产中的临床应用

目的探讨对补佳乐在稽留流产中的临床应用价值进行评价分析,为在今后的临床应用中提供可靠的参考依据。方法将2009-09—2011-09收治的106例稽留流产患者,分为常规组50例,单纯应用米非司酮、米索前列醇;补佳乐组56例,应用米非司酮、米索前列醇、补佳乐,观察2组临床效果。结果补佳乐组完全流产42例(92.85%);常规组完全流产28例(80.00%),经统计学分析P<0.05,差异有统计学意义。结论应用米非司酮、米索前列醇联合补佳乐治疗稽留流产,安全可靠、显著提高完全流产率,降低清宫率。     

疤痕子宫中期妊娠引产的临床研究

目的探讨疤痕子宫中期妊娠药物引产的安全性和可行性。方法将68例疤痕子宫中期妊娠产妇按照引产方式的不同随机分为两组:米非司酮配伍米索前列醇组(36例)和米非司酮配伍利凡诺组(32例)。观察两组引产情况并统计术后并发症。结果米非司酮加米索前列醇引产时间明显短于米非司酮加利凡诺引产(P0.01),引产失败率高于利凡诺组,完全流产率高于利凡诺组,两组自规律宫缩至胎盘排出2h的出血量无显著差异。两组产妇引产后宫颈裂伤、胎盘粘连、胎盘残留、胎膜残留等并发症比例相接近(P0.05)。结论米非司酮配伍米索前列醇、米非司酮配伍利凡诺两种方法用于瘢痕子宫中期妊娠引产安全性比较高,均可行。     

米非司酮对药物流产患者外周血中差异基因表达研究

目的研究米非司酮对药物流产患者外周血中Th1/Th2型细胞因子干扰素-γ(IFN-γ)、IL-2、IL-5、IL-6、IL-10以及细胞因子EDN1、EDNRA、EDNRB、NOS1、NOS2、NOS3、VEGF在药物流产过程中的表达变化。方法收集2014年4~7月就诊于天津医科大学总医院妇产科月经延迟7d以内要求药物流产的孕妇,随机分为两组。A组(5例):第1天口服米非司酮100mg,于2d后口服600μg米索前列醇;B组(6例):第1天口服米非司酮200mg,于2d后口服200μg米索前列醇。两组均分别在服米非司酮前和服米非司酮48h后收集受试者的外周血,采用qRT-PCR方法检测各基因在全血中的mRNA表达水平。结果与同组服用米非司酮前相比较,A组服用米非司酮后EDN1水平显著上调(P0.05),上调至服药前的(2.19±1.20)倍,而B组服用米非司酮后EDN1水平显著下调(P0.05),下调至服药前的(0.49±0.15);A组服用米非司酮后VEGF水平显著上调至服药前的(1.22±0.43)倍(P0.05),而B组服用米非司酮后VEGF水平显著下调(P0.05),下调至服药前的(0.72±0.14);A组和B组中,服用米非司酮前后IFN-γ水平差异无统计学意义(P0.05)。结论在药物流产过程中不同剂量的米非司酮可能存在不同的作用机制;EDN1基因和VEGF基因可能在米非司酮药物流产过程中起着重要的作用。     

米非司酮配伍米索前列醇用于11～14周妊娠引产的临床观察

目的探讨米非司酮配伍米索前列醇用于11～14周妊娠引产的效果。方法对126例妊娠11～14周孕妇,每隔8h口服米非司酮50mg/1次,共3次,末次服药1h后阴道后穹隆放置米索前列醇600μg,专人守侯观察引产效果。结果 126例中120例引产成功,其中阴道放置米索1次成功103例,需2次用药12例,3次用药5例,引产成功率95.2%。结论短间隔分次服用米非司酮配伍阴道放置米索前列醇终止11～14周妊娠安全、简便、有效。     

米非司酮配伍米索前列醇用于终止10～16周妊娠的临床观察

目的 探讨不同方法服用米非司酮配伍米索前列醇终止10～16周妊娠的临床效果.方法 将320例妊娠10～16周妇女随机分为两组,观察不同给药方法终止妊娠的临床效果.结果观察组完全流产率、阴道流血时间与对照组比较,差异有统计学意义 观察组副反应中,发热、恶心、呕吐、腹泻反应与对照组比较有显著性差异（P＜0.01）.结论 米非司酮顿服配伍米索前列醇口服加湿化阴道给药疗效更佳,值得推广应用.     

人工授精手术中不同黄体支持方法作用的研究

目的 探讨不同黄体支持方法与人工授精的妊娠结局及妊娠周期雌二醇（E2）、孕酮（P）、E2/P动态变化规律,黄体支持中合理的E2/P比值,确定合理的黄体支持方法.方法 对接受供精人工授精促排卵助孕治疗的患者172个治疗周期随机分成3组,分别在排卵后第3天开始接受人绒毛膜促性腺激素（hCG）注射（A组）,hCG＋黄体酮注射（B组）和口服黄体酮胶囊（C组）三种不同黄体支持方法,比较三者的妊娠结局,连续检测妊娠周期早卵泡期、排卵期（hCG日）、孕卵着床期（窗口期）,以及早孕期、孕6、7～8周体内E2、P水平.结果 三种不同黄体支持方法中B组妊娠成功率高于其他两组;排卵用药后各个时期P水平C组最高,A、B两组之间无差异;B组与正常妊娠组E2/P比值及变化趋势最相近.结论 hCG＋黄体酮注射组虽无口服黄体酮胶囊组提高P浓度作用显著,但周期妊娠率最高,而且与妊娠对照组E2/P比值及变化趋势最接近,因此在黄体支持不仅要提高P浓度,尚需维持合适的雌孕激素的比值,提示hCG＋黄体酮注射是三种方案中的最佳支持方法.     

Hormonal influence on gastrointestinal reflux during pregnancy

Gastroesophageal reflux (GER) occurs in 30-50% of all pregnancies. The progressive rise in plasma progesterone has been suggested as a possible mediator of GER during pregnancy. It is not known whether progesterone, at physiological concentrations, has an effect on acid contact time. The study includes 70 women--50 pregnant and 20 non pregnant healthy menstruating female volunteers. We used immunoenzymatic tests for determination of estradiol, progesterone and beta HCG hormones during pregnancy. The 50 pregnant women with GER symptoms heartburn, acid regurgitations had increased levels of steroid hormones. 24-h ambulatory esophageal pH monitoring and serum progesterone levels were determined in 20 healthy women known to have normal menstrual cycles. All tests were performed during the follicular phase days 2-7 and the luteal phase days 22-28 of one or two consecutive menstrual cycles. The fluctuations in progesterone levels across the normal menstrual cycle have no significant impact on 24-h ambulatory pH parameters. CONCLUSIONS: Progesterone, at physiological concentrations, does not predispose to GER in healthy menstruating women. Thus, it is likely that if progesterone, with or without estrogen, contributes to GER in pregnancy, this effect takes place only at the high concentrations observed during this condition. After delivery, GER disappear with decreasing hormonal levels and uterine volume.     

Termination of early pregnancy with a reduced oral dose of mifepristone and vaginal misoprostol.

OBJECTIVE: To determine the efficacy of termination of pregnancy with a reduced oral dose of mifepristone and vaginal misoprostol. DESIGN: A retrospective review of 369 medical terminations of pregnancy. SETTING: Northern General Hospital, Sheffield, UK. SUBJECTS: All women presenting for medical termination of pregnancy before 63 days' gestation between October 1996 and December 1997. INTERVENTIONS: Patients were pre-treated with mifepristone 200 mg orally, 36-48 hours before the prostaglandin E analogue, misoprostol, was administered vaginally. Two doses of misoprostol 400 micrograms, were given 2 hours apart. Women were allowed home 6 hours after the first dose of misoprostol. If the products of conception were not passed before going home, patients were to contact the hospital if bleeding did not take place within 4 days. OUTCOME MEASURES: Need for a surgical procedure and number of ongoing pregnancies after full treatment were considered primary outcome measures. RESULTS: A total of 369 women were treated with this regimen: 343 women (93.46%) aborted completely within a 6-hour observation period and did not require further intervention. A further 8 women aborted completely within the next 4 days. Overall, the complete abortion rate was 95.64%. Surgical intervention was necessary in 1.09% of the patients. No woman had serious complications. CONCLUSION: This combination is effective, safe and cost-effective in a clinical setting.     

不同剂量全合成米非司酮配伍米索前列醇终止早孕的临床随机对比研究

对６００例闭经≤４９天早孕健康妇女分别使用单次口服２００ｍｇ或１５０ｍｇ米非司酮后，第三天口服米索前列醇６００μｇ的临床随机对比。结果：两组流产效果相似，完全流产率分别为９３．４％和９２．３％；不全流产率分别为３．３％和３．０％；失败率分别为３．３％和４．７％。绒毛胎囊排出时间、流产后出血和月经恢复情况两组相似。本资料提示，采用米非司酮单次口服１５０ｍｇ后第三天加服米索前列醇６００μｇ，是一种高效、简便、副反应少的药物流产方法。     

复方米非司酮与米非司酮配伍米索前列醇终止早孕的临床分析

目的比较复方米非司酮与米非司酮配伍米索前列醇终止早孕的临床分析。方法将停经49d自愿要求行药物流产、无药物禁忌证的18~40岁妇女随机分为观察组(服用复方米非司酮和米索前列醇终止早孕)和对照组(服用米非司酮和米索前列醇终止早孕)。结果观察组的完全流产率提高,出血量减少,孕囊排出时间和流产后阴道流血时间均缩短。结论复方米非司酮配伍米索前列醇终止早孕临床效果优于米非司酮配伍米索前列醇。     

经阴道小卵泡穿刺术治疗耐克罗米芬多囊卵巢综合征的临床研究

目的探讨经阴道小卵泡穿刺术治疗耐克罗米芬(CC)多囊卵巢综合征(PCOS)不育患者的疗效。方法对11例耐CC的PCOS不育患者,于月经净后3~7 d,在超声引导下经阴道穿刺抽吸两侧卵巢内小卵泡。观察术后的月经变化、两侧卵巢窦卵泡数及性激素水平。结果穿刺后1例行未成熟卵体外培养后妊娠,2例术后8周内妊娠,其余患者月经周期有不同程度的缩短,术后血黄体生成素和睾酮水平下降,但差异无显著性,而两侧卵巢的窦卵泡数明显减少(P<0.05)。结论对于耐CC的PCOS不育患者,单次经阴道小卵泡穿刺术能改善异常的内分泌,缩短月经周期,降低窦卵泡数,自然恢复排卵并妊娠。该手术操作简便、经济、无需住院,还可结合未成熟卵体外培养,是一种比较理想的治疗方法。     

阴道放置米索前列醇终止早孕临床效果分析

观察了阴道放置米索前列醇终止早孕２１５例（实验组），并以口服米索前列醇１９２例作为对照。结果显示：完全流产率，实验组为９５．９％，对照组为９０．１％；副反应率，实验组为６３．３％，对照组为９９．０％，；流产时间，实验组为３．４０±１．７８小时，对照组为２．３９±１．７２小时；出血量，实验组１６．７３±１０．３７ｍｌ，对照组为２２．３３±１２．９７ｍｌ。两组比较，除流产率外均有极显著差异（Ｐ＜０．０１）。认为米索前列醇阴道放置是一种简便、经济、有效和无侵害性的方法，且胃肠道副反应发生率比口服低、米索阴道给药比口服给约药更有效。该药稳定，容易贮存，是终止早孕的好方法，适于临床推广应用。     

A randomized double-blind multicenter study on comparing levonorgestrel and mifepristone for emergency contraception

In1995withtheeducationandpublicityonpreventionofunwantedpregnancywithemergencycontraceptionandtodecreasetheincidenceofabortioninChina,theneedforemergencycontraceptionserviceinfamilyplanningbecomesanimportantissue.Therearemanyavailableemergencycontraception,suchastheYuzperegimen,levonorgestrelonlymethod,danazolandIUDinsertion,butinordertodevelopanacceptableemergencycontraceptionmethodtoChinesewomen,arandomized,double--blindtrialwascarriedouttocomparetheefficacy,side--effectsandtheeffectonthen…     

紫草辅助米非司酮抗早孕对生殖激素的影响

为了探讨紫草辅助米非司酮抗早孕时对早孕妇女血中生殖激素的影响 ,88例早孕妇女随机分成服用米非司酮、紫草、米非司酮加紫草组和空白对照组 ,比较用药前后血人绒毛膜促性腺激素β亚单位 (β-h CG)、卵泡刺激素 ( F SH)、黄体生成素 ( L H)、雌二醇 ( E2 )、孕酮 ( P)和睾酮 ( T)的变化。结果 :单用米非司酮或紫草均对 β-h CG有一定的抑制作用 ,二者合用抑制作用更加明显 ;单用紫草对血中 FSH、 L H有较明显的抑制作用 ,对 E2 、P及 T无明显影响。认为紫草对绒毛功能有一定的影响 ,与米非司酮合用影响更明显 ;紫草对垂体生殖激素有明显的抑制作用。但是否与紫草能提高药物流产效果有关 ,尚需进一步研究。     

Nausea and vomiting after gynaecological laparoscopy depends upon the phase of the menstrual cycle

Postoperative nausea and vomiting were compared in 68 women with regular menstrual periods undergoing gynaecological laparoscopy. The patients were divided into four group on the basis of the phase of the menstrual cycle as follows: premenstrum-menstrum (pre + menstrum) (Pd 25-6), early follicular phase (Pd 8-12), ovulatory phase (Pd 13-15) and luteal phase (Pd 20-24). The overall incidence of nausea and vomiting was 46%. Statistically significant differences in the incidence of nausea and retching were found among the groups by regression analysis. The incidence of nausea and vomiting was highest in women undergoing laparoscopy during the luteal phase (77%), which was greater than during the follicular phase (32%) or during pre + menstruation (18%). The need for antimetic was highest in women undergoing laparoscopy during the luteal phase (69%) and this was different from the follicular (18%, P less than 0.01) and pre + menstrum (19%, P less than 0.01) phases. It is concluded that the highest incidence of postoperative nausea and vomiting after gynaecological laparoscopy occurs during the luteal phase.