米非司酮配伍利凡诺溶液用于瘢痕子宫中期妊娠引产临床分析

目的探讨米非司酮配伍利凡诺溶液用于瘢痕子宫中期妊娠引产的安全可行性。方法2005年1月至2008年10月，将自愿要求终止妊娠的瘢痕子宫中期妊娠孕妇115例，随机分为观察组（n：64）和对照组（ n=51）（本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准，分组征得受试对象本人的知情同意，并与之签署临床研究知情同意书）。观察组经腹壁向羊膜腔内注入0．5％利凡诺溶液20mL，随即一次顿服米非司酮片150mg。对照组仅羊膜腔内注射0．5％利凡诺溶液20mL。观察并记录两组孕妇羊膜腔注药至宫缩开始时间、宫缩至胎盘娩出时间、术中疼痛程度、术后24h出血量、宫颈裂伤等情况及不良反应。结果观察组完全流产率（90．63%，58／64））明显高于对照组（70．59％，36／51）（P〈o0．05），注药至宫缩开始时间[（26．71±10．73）hl、宫缩至胎盘娩出时间[（5．76±3．16）hl均短于对照组（36．28±12．35）h，（8．25±3．76）h]（P〈0．01），术中疼痛I级发生率（42．19％，27／64）高于对照组（21．57％，11／51）（P〈0．05），术后24h出血量[（103．29±26．72）mL]少于对照组[（141．36±82．51）mL]（P〈0．01），观察组宫颈裂伤发生率（0，0／64）低于对照组（9．80％，5／51）（P〈0．01）。结论米非司酮配伍利凡诺用于瘢痕子宫中期妊娠引产效果较好，方法简单安全，值得推广应用。

Clinical Study on the Value of Mifepristone Combined With Rivanol Used in Induction of Labor in the Second Trimester for Scarred Uterus

Objective To evaluate the effect and security of mifepristone combined with rivanol used in the induction of labor in the second trimester for the scarred uterus. Methods From January 2005 to October 2008, 115 women asking for termination of second trimester pregnancy were randomized into two groups： observation group （n± 64） and control group （n± 51）. Informed consent was obtained from all participates. Observation group were administered induced labor through amniotic injection of rivanol 100 mg before took mifepristone orally （150 rag）, and the women in control group were administered routine induced labor through amniotic injection of rivanol 100 mg only. Duration of uterine contraction and uterine contraction, duration of uterine contraction and placental expulsion, pain grading, the amount of hemorrhage within 24 hours after the surgery, and cervical laceration were observed between observation group and control group. Results The rate of complete abortion in observation group （90.63% ,58/64） was higher than that of control group（70.59%, 36/51）, which had significantly difference. The duration from injection to uterine contraction, duration from uterine contraction to placental expulsion of observation group [（26.71±10. 73）h, （5. 76±3. 16） hi were shorter than those of control group E（36. 28 ±12. 35） h, （8.25±3.76） h]（P〈0.01）. The rate of pain grading I in observation group （42.19%,27/64） was higher than that of control group （21.57%,11/51） （P〈0.01）, and postpartum hemorrhage within 24 hours after the surgery in observation group [（103.29± 26.72） mL] was less than that of control group [（141.36± 82.51） mL]（P〈0. 01）. And the incident rate of cervical laceration of observation group （0,0/64） was lower than that of control group （9. 80%, 5/51）（P〈0.01）. Conclusion Mifepristone combined with rivanol used in the induction of labor in the second trimester for the scarred uterus is effeetive, safe, and simple.