戊酸雌二醇配伍米索前列醇在稽留流产中的应用价值

目的探讨戊酸雌二醇配伍米索前列醇在稽留流产中的应用价值。方法选择2011年7月至2012年7月北京积水潭医院门诊就诊的、孕周≤13周稽留流产患者77例,征求患者意愿分成药物流产组(A组42例)及人工流产组(B组35例),A组再随机分成A1组(22例)和A2组(20例)。所有患者均先口服戊酸雌二醇5 mg,每日3次,连服3 d。A1组患者于第4天口服米索前列醇600μg;A2组于第4天口服米非司酮150 mg,第6天口服米索前列醇600μg;B组患者35例,直接行清宫术治疗。观察A1、A2、B组3组疗效。结果 A1与A2组相比,完全流产率、米索前列醇用量、胎囊排出时间、胎囊排出后阴道出血量、月经复潮时间相比无统计学差异(P0.05);A1组胎囊排出时出血量多于A2组,但胎囊排出后阴道出血时间明显少于A2组(P0.05)。A1组与B组比较,A1组胎囊排出后阴道出血量稍多于B组(P0.05),而胎囊排出或手术中出血量、术后出血时间、月经复潮时间相比差异均无统计学意义(P0.05)。结论米非司酮配伍米索前列醇应用于治疗稽留流产与单用米索前列醇相比并未增加完全流产率,戊酸雌二醇配伍米索前列醇治疗稽留流产,疗效可靠,值得推广。

Application value of Estradiol Valerate combined with Misoprostol in missed abortion

Objective To explore the application value of Estradiol Valerate combind with Misoprostol in missed abortion. Methods 77 patients in the outpatient department of Deijing Jishuitan Hospital with missed abortion and gestational age ≤13 weeks from July 2011 to July 2012 were selected,all patients were divided into medical abortion group（group A 42 cases）and surgical abortion group（group B 35 cases）with patients’agreement,medical abortion group were further divided into group A1（22 cases）and group A2（20cases）. All patients first took Estradiol Valerate 5 mg,tid,for 3 days. patients in group A1 then took Misoprostol 600μg at the 4th day,patients in group A2 took Mifepristone 150mg at 4th day and misoprostol 600 μg at the 6th day. 35 patients in group B received curettage. Clinical effect of 3 groups were observed. Results There were no statistical differences between A1 and A2 group in complete abortion rate,Misoprostol dosage,discharge time,vaginal bleeding after discharge sac,the time of return of menses（P〉 0. 05）. The bleeding amount of sac discharge in A1 group were more than A2 group,but the vaginal bleeding time after sac discharge in A1 group were shorter than A2 group（P〈 0. 05）. The bleeding amount after sac discharge in A1 group were more than B group（P〈 0. 05）,but sac discharge or operation blood loss,postoperative bleeding,the time of return of menses had no statistical differences between the two groups（P〉 0. 05）. Conclusion Compared with Misoprostol along,mifepristone combined with misoprostol used in the treatment of missed abortion do not increase the complete abortion rate,The clinical efficacy of Estradiol Valerate combined with Misoprostol is satisfactory,and the method is worthy to be popularized.