单独应用米索前列醇紧急避孕临床效果观察

目的研究女性黄体早期单独应用米索前列醇进行紧急避孕的有效性、安全性和可接受性。方法采用前瞻性临床研究,选择符合接收标准、要求紧急避孕、并愿意参加本课题研究的221例育龄妇女作为研究对象。分米索前列醇组(78例)、米非司酮组(71例)、无避孕组(72例)三组,米索前列醇组空腹顿服米索前列醇200μg×2片,米非司酮组单次口服米非司酮25mg,预约预期下次月经后10d内随访。观察在黄体早期用药后的妊娠率、月经的变化和副作用。结果①米索前列醇组1例妊娠,失败率为1.3%,米非司酮组无妊娠,失败率为0;无避孕组12例妊娠,失败率为16.7%,米索前列醇组、米非司酮组与无避孕组间均有显著性差异。米非司酮组与米索前列醇组之间无显著性差异。②随访时米索前列醇组77例、米非司酮组71例及无避孕组60例月经已经来潮,米索前列醇组及米非司酮组开始出血时间早于无避孕组,经检验有显著性差异(p<0.05),而米索前列醇组与米非司酮组之间无差异(p>0.05);出血持续时间3组间无显著性差异,与正常月经经期基本一致。③应用两种药物均无不良后果,副作用轻,能自行缓解。结论黄体期单独应用米索前列醇紧急避孕也是有效、安全和可行的方法。     

用复方米非司酮配伍米索前列醇避孕的临床研究

目的:探讨女性黄体期应用复方米非司酮配伍米索前列醇进行避孕的有效性和安全性。方法:选择多次无避孕性生活或无避孕性生活结束超过120 h要求紧急避孕的142例妇女,于预期月经来潮前10天内服用复方米非司酮,并于服用复方米非司酮48h后加服米索前列醇。观察是否妊娠和下次月经的情况。结果:142例妇女妊娠2例,失败率1.5%。140例均有月经来潮,黄体早期组开始出血时间显著早于其他两组(P0.05),出血持续时间3组间无显著性差异,与正常月经经期基本一致。结论:在黄体期使用复方米非司酮配伍米索前列醇,是一种安全、有效的避孕补救方法。     

米非司酮联合三苯氧胺配伍米索前列醇终止早孕的临床观察

目的:观察米非司酮与三苯氧胺合用,续贯以米索前列醇,终止早孕的流产效果、流产后出血时间及药物副反应的情况,并与单用米非司酮续贯米索前列醇的药流方法进行比较。方法:将自愿选择药物流产的健康早孕妇女随机分成研究组和对照组,研究组采用米非司酮联合三苯氧胺配伍米索前列醇的方法终止早孕,米非司酮总量75 mg,三苯氧胺总量80 mg,第3天晨空腹口服米索600μg。对照组采用米非司酮续贯米索前列醇的方法,米非司酮150 mg,分3天服用,第4天晨空腹口服米索600μg。结果:研究组的完全流产率、阴道出血量、药物副作用及月经恢复时间与对照组相比均无明显差异(P>0.05),而阴道平均出血时间,研究组(8.2±3.5)天,对照组(13.3±4.6)天,两组相比有显著性差异(P<0.05)。结论:小剂量米非司酮联合三苯氧胺配伍米索前列醇终止早孕,可以减少药流后出血时间。     

米非司酮配伍不同途径应用米索前列醇的临床观察

本文对８５例足月妊娠初孕妇，采用米非司酮配伍与不同途径给予米索前列醇进行引产。结果为置入组胎儿宫内窘迫发生率显著高于口服组；两组在末次用药至临产，总产程，产后出血，新生儿窒息等方面无显著差异。提示：序贯口服米非司酮及米前列醇有利于计划分娩，是一种安全有效的引产方法。     

药物流产不同用药途径的临床比较分析

目的:探讨药物流产的临床用药途径.方法:选择60例要求药物终止早期妊娠的患者作为观察对象,按照不同临床给药途径,分为甲组和乙组,甲组为米非司酮100g 24h内米索前列醇阴道给药;乙组为米非司酮200g 48h内米索前列醇阴道给药.分别观察两组的用药效果.结果:两组均实现完全流产,且在流产率、副作用、术后出血等方面基本一致.结论:从减少病人花费、缩短药物流产时间的角度考虑,米非司酮100mg配伍米索前列醇24h用药终止早期妊娠的方案更容易为患者所接受.     

米非司酮配伍米索前列醇终止孕12周内胚胎停育105例

目的 观察米非司酮伍用米索前列醇或单用米索前列醇治疗妊娠12周内宫内胚胎停育的临床效果. 方法 妊娠12周宫内胚胎停育者105例采用米非司酮和米索前列醇流产(简称双米组),102例单纯采用米索前列醇流产(简称米索组),两组3h后行清宫术,随访1年. 结果 双米组手术时间、术中出血量、出血天数均少于米索组,差异有统计学意义;双米组清宫次数,月经恢复时间少于米索组,1年内再次妊娠比例高于米索组,但差异均无统计学意义. 结论 米非司酮和米索前列醇配伍流产方法能缩短手术时间,减少术后不良反应.     

三种终止中期妊娠方法的比较

目的:探讨三种终止中期妊娠方法的疗效.方法:180例中期妊娠患者随机分为三组,利凡诺羊膜腔内注射法58例,米非司酮配伍米索前列醇法62例,米非司酮联合利凡诺羊膜腔内注射法60例,比较三组引流产效果.结果:米非司酮配伍米索前列醇法和米非司酮联合利凡诺羊膜腔内注射法引产有效率明显高于利凡诺羊膜腔内注射法,且有效引产时间明显缩短,但米索前列醇的副作用多且明显.结论:米非司酮联合利凡诺羊膜腔内注射法终止中期妊娠引产有效率高,引产时间短,副作用小.     

米非司酮配伍不同剂量米索前列醇药物流产效果观察

目的:探索米非司酮配伍不同剂量米索前列醇终止早孕的最佳方案,以缩短流产出血时间。方法:将900例妊娠≤49天,要求药物终止妊娠的妇女,随机分为A组300例,米非司酮首次剂量50mg,后1次/12h,每次25mg,服用3天,于第3天晨服米索前列醇0.6mg,第4～6天早晨再各服0.2mg,总剂量为1.2mg;B组300例,米非司酮的用法相同(总量为150mg),第3天晨服米索前列醇0.6mg,隔2h再次服米索前列醇0.4mg,共2次,总剂量1.4mg;C组300例,米非司酮用法相同,第3天晨服米索前列醇0.6mg。结果:A、B、C组完全流产率分别为98.33%、97.67%和95.67%,各组间比较差异无显著性(P>0.05)。3组出血天数分别为(9.2±2.8)天、(9.5±2.9)天和(12.8±3.2)天,A、B组与C组比较有显著性差异(P<0.01),副反应比较差异无显著性(P>0.05)。结论:米非司酮配伍不同剂量米索前列醇用药可提高完全流产率,缩短药物流产出血时间,不增加副反应。     

米非司酮配伍米索前列醇用于稽留流产115例临床观察

目的通过对115例稽留流产患者行米非司酮配伍米索前列醇的应用、总结、分析,探讨米非司酮配伍米索前列醇在临床的应用.方法对我科115例稽留流产患者行米非司酮配伍米索前列醇的资料回顾性分析,其中84例用药后完全流产;26例行清宫术;4例(其中2例是瘢痕子宫妊娠)流产失败,未见妊娠组织排出,行清宫术;1例为试管婴儿,行清宫术复查盆腔B超仍有残留组织而行宫腔镜下电切术.结论米非司酮配伍米索前列醇治疗稽留流产具有创伤小,恢复快,费用低,给药途径简单,副作用小,可见基层医院广泛应用.     

米索前列醇2种给药途径终止10～16周妊娠效果比较

目的观察米非司酮配伍米索前列醇不同用药途径对10～16周妊娠的流产效果。方法将168名妊娠10～16周的健康妇女随机分配给以米非司酮150mg后,83例米索前列醇阴道给药、85例米索前列醇空腹口服终止妊娠。结果2组在流产时间、出血量差异无统计学意义(χ2=0.075,P>0.05),口服米索前列醇比阴道给药的不良反应增加(χ2=11.53,P<0.05)。结论米非司酮配伍米索前列醇2种用药途径对10～16周妊娠的终止是有效安全简便方法,在减少不良反应方面米索前列醇用药途径阴道给药组优于口服组。     

黄体期避孕对月经影响的临床研究

目的:评估当妇女在月经周期有无保护性生活超过120h,或多次无保护性生活后于黄体期避孕对月经的影响。方法:在黄体期1次性服用米非司酮100mg并在36~48h后服用米索前列醇400μg,服药后观察月经情况。结果:100例受试者中4例妊娠,在成功避孕的96例中,月经提前68例(70·83%),延期15例(15·6%),无改变13例(13·5%)。服药前后比较,月经周期缩短,差异有显著性意义(P<0.01),服药后月经出血天数5·76±1·18天,与妇女原来出血天数比较差异有显著性意义(P<0.05),与服药前自身经量比较,经量减少1例,相似90例,增多5例,经量与服药前差异无显著性意义(P>0.05)。服药距下次月经时间为6·85±1·88天,服药距下次月经9~7天组和6~4天组月经周期缩短,与服药前相比差异均有显著性意义(P<0.05),而3~1天组月经周期改变不明显(P>0.05);出血天数及经量3组间无显著性差异(P>0.05)。结论:黄体期避孕有效率为96%,该方法可使妇女月经周期缩短,经期延长,且服药距下次月经时间长对月经周期影响较大。     

Summary of evidence and research needs on the use of mifepristone in fertility regulation: consensus from the conference

The conference on the use of mifepristone to reduce unwanted pregnancy, sponsored by the World Health Organization, Concept Foundation and the Rockefeller Foundation, took place in Bellagio, Italy, between 24 and 28 September 2001. The objective of the conference was to review the scientific information and to evaluate the use of mifepristone for emergency contraception, luteal contraception and menstrual induction. Mifepristone is highly effective for emergency contraception but its advantages and disadvantages in comparison with levonorgestrel need to be further studied. Data indicate that mifepristone alone or in combination with misoprostol has potential for occasional use for women seeking help following repeated unprotected intercourse and/or when the interval between intercourse and treatment is more then 120 h. Administration of mifepristone immediately after ovulation seems to be an effective contraceptive method. However, before it can be used commonly, there is a need for a simple and inexpensive method to identify the right time in the cycle. Once-a-month treatment with mifepristone and misoprostol at the expected time of menstruation is not a practical method due to bleeding irregularities and timing of treatment. Menstrual induction with mifepristone and a suitable prostaglandin analogue is highly effective. A randomized comparison with manual vacuum aspiration is, however, needed before it can be recommended for routine use.     

黄体期使用米非司酮配伍米索前列醇避孕对月经影响的临床研究

目的:探讨妇女在无保护性生活超过120h,或多次无保护性生活后在黄体期使用米非司酮配伍米索前列醇避孕对月经的影响。方法:观察对象在黄体期一次性服用米非司酮100mg并在36～48h后服用米索前列醇400μg,服药后随访2个月经周期。结果:在成功避孕的289例(98.6%)中,服药前月经周期29.36±2.14d,服药当月月经周期26.15±3.68d,差异有统计学意义(t=15.498,P<0.05);服药前经期5.42±1.02d,服药后当月经期5.61±1.09d,差异有统计学意义(t=-4.143,P(0.05);服药后当月经量与自身既往经量比较,无变化215例(74.4%),减少59例(20.4%),增多15例(5.2%)。服药后次月月经周期为29.65±2.82d,与服药前相比差异无统计学意义(t=-1.922,P>0.05);经期5.46±1.03d,与服药前比较差异无统计学意义(t=-1.609,P>0.05);经量无变化273例(94.5%),减少10例(3.5%),增多6例(2.1%)。服药距预计月经时间越长月经提前的时间就越长(F=3.445,P<0.05)。结论:妇女黄体期使用米非司酮配伍米索前列醇避孕有效率高,可使服药当月月经周期缩短、经期延长,且服药距预计月经时间越长对月经影响越大,但对以后月经无影响。     

Luteal phase treatment with mifepristone and misoprostol for fertility regulation

Emergency contraception (EC) with 10 mg mifepristone can prevent pregnancy up to 5 days after a single act of unprotected intercourse. No methods have been shown to be effective when treatment is administered more than 5 days after a single unprotected act or after several unprotected acts. Therefore, we tested, among 699 Chinese women requesting EC and exposed to the risk of pregnancy described, the potential of 100 mg mifepristone followed 2 days later by 0.4 mg misoprostol orally, when administered in the luteal phase of the cycle. At the time of treatment urinary pregnancy test had to be negative. Despite treatment, 25 women (2.7%) became pregnant. Among women with treatment delayed more than 5 days, the pregnancy rate was related to the number of acts of intercourse before treatment, being 1.4% with one episode and increasing to 6.5% when the number of episodes was two or more (relative RISK = 4.62, 95% CI: 1.06–20.18). Side effects within a week after treatment were mild, and most women (57.2%) had menstruation within 3 days as expected. An occasional treatment with mifepristone in combination with misoprostol could provide an option for preventing unwanted pregnancies in women who are late for EC.     

三种不同方法用于紧急避孕的临床观察

目的:观察三种方法用于紧急避孕的临床效果。方法:选择接收无保护性生活或避孕失败72小时内要求紧急避孕的健康育龄妇女354例。组Ⅰ(119例),单次口服米非司酮25mg(25mg/片);组Ⅱ(120例),左炔诺酮首次口服0.75mg(0.75mg/片),间隔12小时再服0.75mg;组Ⅲ(115例):放置含铜IUD。以服药或放置IUD后月经来潮为成功标准,以Dixon表格计算避孕有效率。结果:三组共有3例失败,均显著低于预期妊娠数(10.945,9.516,8.461)(P<0.05);避孕有效率分别为81.7%、89.5%、100%。对下次月经影响均较轻微(P>0.05),组Ⅰ副反应发生率明显低于组Ⅱ(P<0.01)。结论:三种方法用于紧急避孕安全、有效、简便。     

Mifepristone for luteal phase contraception

The concept of luteal phase contraception and the use of mifepristone in clinical trials, which allows for testing of its validity, as well as clinical pharmacological research designed to understand its mode of action, are reviewed. Early luteal phase administration has a variety of morphological, physiological and biochemical effects on the endometrium that are likely to interfere with embryonic–endometrial interactions. In fact, specifically designed pilot clinical trials as well as data derived from emergency contraception studies indicate that early luteal phase administration of mifepristone is highly effective in preventing pregnancy, with minimal disturbance of hormonal parameters or menstrual cyclicity. Mid and late luteal phase administration of mifepristone at doses above 25 mg are highly effective in inducing endometrial bleeding in nonconceptional cycles. However, administration of mifepristone within the period between implantation and expected menses fails to induce bleeding in a significant proportion of cases, and furthermore the bleeding induced does not insure the termination of pregnancy. While the data suggest there is potential for a once-a-month contraceptive pill, it is likely that no molecule endowed with partial agonistic properties, like mifepristone, will completely and reliably suppress the essential functions of progesterone in order to achieve contraceptive efficacy comparable to that of modern contraceptive methods.     

桂枝茯苓胶囊减少药物流产后阴道出血286例临床观察

目的:观察桂枝茯苓胶囊对药物流产后阴道出血情况的影响。方法:自愿要求药物流产的早孕妇女随机分为治疗组160例,对照组126例。治疗组常规服用米非司酮+米索前列醇(简称双米)的同时加服3粒桂枝茯苓胶囊,孕囊排出后,继续服用茯苓胶囊7天,对照组服用双米+安慰剂。结果:两组在孕囊排出时间上无显著差异;阴道出血量及出血持续时间,治疗组优于对照组(P<0.05)。结论:桂枝茯苓胶囊可减少药物流产后阴道出血量,缩短出血时间,推荐临床应用。     

米非司酮不同服用方法对皮下埋植术后子宫出血影响的观察

目的:探讨米非司酮不同服用方法对皮下埋植避孕术后子宫异常出血的影响。方法:120例行皮下埋植避孕术妇女随机分为3组,每组40例。对照组不服用任何药物;一日组在埋植日和每月月经来潮当日服米非司酮50mg,共服6次;两日组在埋植日和每月月经来潮当日、次日各服米非司酮25mg,共服6次。结果:服用米非司酮期间出血天数和滴血天数较对照组减少(P<0.01),经期延长和长期不规则出血百分率低于对照组(P<0.05),但一日组和两日组间差异无显著意义(P>0.05)。停药后组出血天数较对照组明显减少(P<0.05)、滴血天数差异无显著性意义(P>0.05),一日组和两日组间差异无显著性意义(P>0.05)。结论:皮下埋植术后单次服用米非司酮可以改善术后子宫异常出血。     

舌下含服米索前列醇对药物流产结局影响的临床研究

目的:探讨舌下含服米索前列醇对药物流产结局的影响。方法:将208例妊娠天数<49天的早孕妇女随机分组,对照组常规口服米非司酮配伍米索前列醇,观察组口服米非司酮配伍舌下含服米索前列醇,药物剂量相同。结果:观察组和对照组完全流产率分别为96.0%和89.1%,不全流产率为3.0%和5.9%,流产失败率为1.0%和5.0%(P<0.05);两组阴道持续出血时间分别为12.8±4.4天和13.1±4.5天,两组出血量无显著性差异;观察组中出现寒颤的例数比对照组明显增加(P<0.001),其它副反应比较无显著性差异(P>0.05)。结论:应用米非司酮片配伍舌下含服米索前列醇可提高完全流产率,值得临床推广。