两种国产皮下埋植剂月经异常主诉的危险因素分析

本文采用国家“八、五”科技攻关项目“国产皮下埋植避孕方法多中心研究(扩大应用)”资料,分析中国妇女使用国产皮下埋植剂后月经异常发生率及影响因素.月经异常是皮下埋植剂最主要的副反应,埋植后半年内,一半以上的妇女主诉有月经异常发生.采用单因素和 Logistic多元逐步回归对月经异常副反应进行分析.结果表明:月经异常主诉与年龄、文化程度、体重、埋植时是否哺乳、末次妊娠结局、末次避孕方法和埋植剂类型有关.年纪轻的妇女主诉有月经异常者多于年纪大的妇女;文化程度高的妇女主诉有月经问题的比例高于文化程度低的妇女;体重轻者较体重重者月经异常主诉多;哺乳期埋植的妇女“出血”主诉较不哺乳妇女少,但“稀少闭经”主诉多于不哺乳妇女;末次妊娠结局为人流的妇女“出血”主诉较多;埋植前使用口服药的妇女”出血”主诉较少,埋植前使用IUD的妇女”稀少闭经”主诉较少;Ⅰ型埋植剂使用者“稀少闭经”主诉高于Ⅱ型使用者.本研究结果提示:应在手术前根据使用者年龄、文化程度、以往避孕史和体检情况等耐心、细致、正确和全面地做好咨询服务工作.以提高皮下埋植避孕方法的可接受性.     

国产Ⅱ型皮下埋植避孕剂避孕方法的临床应用分析

目的探讨国产Ⅱ型皮下埋植避孕剂的临床应用效果，分析其不良反应及处理，方法。方法收集2000—2003年皮下埋植术227例与458例绝育手术、254例放置宫内节育器术者的资料进行对比分析，以了解国产Ⅱ型皮下埋植避孕剂的使用效果。结果该方法简便、创伤小，可逆，取出6个月后即可生育；一般妇科炎症与埋植术无相关性；避孕有效率高，其中月经紊乱、不规则是要求终止的一些主要因素。结论强化规范手术操作，术后加强随访，及时诊治副作用，可以提高皮下埋植避孕剂的临床应用率。     

国产Ⅱ型皮下埋植剂5年临床观察

目的:探讨国产Ⅱ型皮下埋植剂的5年临床应用效果。方法:对572例接受国产Ⅱ型皮下埋植剂的对象随访,观察5年妊娠率、主要副反应、终止使用的主要原因。结果:随访率98.3%,妊娠2例,5年累积妊娠率0.35%,月经问题是终止使用的主要原因,占终止数的93%,1-5年累积续用率分别是88.81%、84.44%、81.29%、68.04%、62.93%。结论:国产Ⅱ型皮下埋植剂可以使用5年,是一种长效、安全、可逆的最有效避孕方法之一,值得临床推广使用。     

两种国皮下埋植剂月经异常主诉的危险因素分析

本要用国家“八五”科技攻关项目，“国产皮下埋植避孕方法多中心研究（扩大应用）”资料，分析中国妇女使用国产皮埋植剂后月经异常发生率及影响因素，月经异常是皮下埋植剂最主要的副反应，埋植后半年内，一半以上的妇女主诉有月经异常发生，采秀单因素和Ｌｏｇｉｓｔｉｃ多元逐步回归对月经异常副反应进行分析，结果表明；月经异常主与年龄，化程度，体重，埋植时是否哺乳，末次妊娠结局，末次避孕方法和埋植剂类型有关，年龄     

Norplant皮下埋植剂长期使用的有效性临床研究—八年经验

上海医科大学妇产科医院于１９８４年１０月至１９９３年１２月应用Ｎｏｒｐｌａｎｔ皮下埋植剂１６５７例（其中Ｎｏｒｐｌａｎｔ—Ⅰ型１３５６例，Ｎｏｒｐｌａｎｔ－Ⅱ３０１例）控制生育。１、３、５、６、７、８年的累积妊娠率分别为０、０．１、０．９、１．７、２．６、和３．３／１００妇女；妊娠率与最初埋植时的体重有关，体重重者妊娠率高。持续使用率分别为９７．１、８２．２、７３．５、４４．７、３４．３和１８．５／１００妇女。主要副反应为月经失调，是终止使用的主要原因；但总失血量不多，随着使用时间的延长，月经失调副反应逐渐减少。埋植剂的放置和取出技术易于掌握，在１６５７例使用中，未发生感染或其他并发症，使用安全。由于其妊娠率低，和不可能脱落及其高度可逆性，深为受术者欢迎。     

因月经异常停用国产皮下埋植剂的影响因素分析

本文采用国家“八·五”科技攻关项目“国产皮下埋植避孕方法多中心研究 (扩大应用 )”资料 ,分析中国妇女使用国产皮下埋植剂后因月经异常停用的影响因素。月经异常是皮下埋植剂最主要的停用原因 ,二年末因月经异常的累积停用率 I 型和 II 型分别为8.96 %和 7.84%。采用 COX多元逐步回归分析因月经异常停用的影响因素。结果表明 :文化程度高、产次低者因闭经停用的风险率较高 ,农民较其它职业者因闭经停用的风险率低 ,I型埋植剂因闭经停用的风险率高于 II型 ;文化程度高、体重轻、埋植时不哺乳、产次低、末次避孕方法使用 IUD或屏障法者因“其它”月经异常 (指除闭经以外的其它月经异常 )停用的风险率较高。农民较其它职业者因“其它”月经异常停用的风险率低 ;不同地区的妇女因月经异常停用的风险率不同。本研究结果提示 :应在手术前有针对性地做好咨询服务工作 ,以提高皮下埋植避孕方法的可接受性     

NORPLANT皮下埋植避孕剂使用的有效性及其副反应的评价

本研究于1984年10月至1987年9月应用Norplant皮下埋植剂1470人(其中Nor-Plant-Ⅰ1169人,Norplant-Ⅱ301人)控制生育。12个月和24个月的避孕效果:累积的妊娠率分别为0.2%和0.3%,持续使用率分别为96.5%和86.2%。主要副反应:月经不规则是终止使用的主要原因;但总失血量不多。Norplant埋植剂使用1年和2年后测定血红蛋白均值略有升高;血压无变化;体重略有增加。埋植剂的放置和取出易于掌握,在1470名使用者中未发生感染或其他并发症,使用安全。由于其妊娠率低和不可能脱落及其高度可逆性,深为受试者所欢迎。     

血浆内皮素与皮下埋植剂使用者子宫异常出血相关性初步探讨

目的:初步探讨血浆内皮素与皮下埋植剂使用者子宫异常出血的相关性。方法:采用前瞻性自身对照研究方法,对29名妇女在埋植手术前后月经周期不同阶段取4次静脉血;本研究前已使用皮下埋植剂的59名随访妇女组成已埋植组,取1次静脉血。应用放免方法测定血浆内皮素、雌激素、孕激素含量。结果:29例自身对照组妇女雌激素水平不论在月经周期的哪一阶段与埋植前比较均无明显改变,埋植后月经紊乱者较月经正常者雌激素、孕激素水平也无明显差异,血浆内皮素水平月经紊乱者偏高（但尚无统计学差异）,且月经紊乱者较月经正常者埋植前月经周期各阶段血浆内皮素水平也明显增高,尤以早增期、中增期明显,P<0.05。已使用埋植剂组的59名妇女,月经紊乱者血浆内皮素水平较月经正常者血浆内皮素也明显增高,P<0.05。结论:血浆高内皮素水平可能和埋植后子宫异常出血存在一定关系。     

Norplant皮下埋植剂使用者生殖激素水平及卵泡发育特征研究

本研究对69例皮下埋植避孕者根据阴道出血类型不同分为月经规则组、月经紊乱组、闭经组，并对其分别进行生殖激素测定，监测卵泡生长发育及宫颈评分。结果表明：埋植期间月经规则组除黄体期P水平较正常对照组降低外（P＜0．01），其它生殖激素均在正常范围内波动；月经紊乱组及闭经组P和E2低于正常对照组黄体期，相当于正常对照组卵泡期低水平。B超监测卵泡表现三种类型：1．卵泡逐渐成熟并排卵；2．卵泡逐渐长大并在整个周期内持续存在；3.卵泡未发育。研究结果提示黄体功能不足是皮下埋植避孕的作用机理之一，并说明皮下埋植者月经失调和生殖激素及卵泡发育特征之间的变化与LNG的抑制有关，研究结果进一步证实皮下埋植剂具有高效、安全的优点，对扩大推广应用皮下埋植避孕法起到指导作用。     

国产长效皮下埋植避孕剂与Norplant多中心临床对比研究

目的 :观察两种国产皮下埋植避孕剂 I型、II型和 Norplant埋植剂的避孕效果、副反应和可接受性。方法 :采用前瞻性、随机分配原则的研究方法 ,在全国 1 0个临床中心开展本专题临床研究。统一研究方法 ,统一科研表格。每年随访一次 ,共随访 5年。结果 :共接收对象 2 999例。国产 型组 1 0 0 1例 , 型组 1 0 0 0例 ,Norplant组 998例。 5年随访率为 99.8%。 5年末 ,国产 型组 ,妊娠 3例 ,粗累积妊娠率 0 .4/1 0 0妇女。国产 型组 ,妊娠 5例 ,粗累积妊娠率 0 .7/1 0 0妇女。Norplant组无妊娠 ,三组间无统计学差异 ( P>0 .0 5 )。三组均无宫外孕发生。 5年末 ,三组共终止 82 2例。继续累积使用率 ,分别为 73.9,68.4和 75 .5 /1 0 0妇女。经 Log- Rankχ2 检验 ,三组无统计学意义 ( P>0 .0 5 )。月经问题是终止的主要原因。随埋植时间延长 ,月经出血模式正常比率明显增加。血红蛋白有上升趋势。 5年内未发生重大健康问题。结论 :国产皮埋剂 I型、II型和 Norplant是高效、长效、安全的节育方法     

国产18甲基炔诺酮皮下埋植剂和Norplant的临床比较性研究——666例4年报告

本文旨在研究国产18甲基炔诺酮皮下埋植剂避孕的有效性及其副反应,与Norplant作比较.666例对象经过4年观察.国产组共发生4例妊娠,4年累积妊娠率为1.07/100妇女,年平均妊娠率为0.27/100妇女,4年累积的续用率为76.6/100妇女.与国外Nor-Plant组相比较,都无统计学差异.两组副反应亦相似,主要均为月经失调,占终止者的半数以上.国产组的左旋18甲基炔诺酮的血药水平下降得较快,2年以后略低于Norplant组,但到48个月时仍在抑制排卵的血药水平.4年临床观察国产组与Norplant相似,都具有长效、高效、可逆、稳定的优点,是可供育龄妇女选用的新避孕法.     

含药含气IUD与TCu 380A IUD临床比较性研究

本文介绍一种新型合药含气IUD，系由硅橡胶、聚乙烯、聚氨酯构成，内含微小空气间隙和定量消炎痛。研究分为两组，组Ⅰ为含药含气IUD408例，与组ⅡTCu380A408例进行随机比较性研究，随访一年两组随访率达100％。结果显示：组Ⅰ与组Ⅱ粗累积存放率分别为97．8％、96．8％；累积妊娠率分别为0．99％和0．49％；累积脱落率分别为0．49％和1．24％。两组因疼痛和出血取出率分别为0．74％（Ⅰ）、1．5％（Ⅱ），上述两组均未显示统计学差异（P＞0．05）。表明含药含气IUD和TCu380AIUD均有较好的安全性、有效性和可接受性，而合药含气IUD出血量则显著低于TCu380A（P＜0．01）。     

Minipill: miniprotection from ectopic pregnancy

The progestogen-only minipill appears to offer only minimal protection against ectopic pregnancy according to 3 reports. In 1 report, 2 ectopic pregnancies occurred among 135 women taking .35 mg norethisterone for a total of 1024 woman-months, and 2 other ectopic pregnancies occurred in a group of women who completed 650 woman-months, yielding and approximate rate of 2/100 woman per year of use. In another report, 3 ectopic pregnancies were found among a group of 535 women using minipills for 4594 woman-months. Of these, 1 woman had used .5 mg chlormadinone acetate daily, another .35 mg norethisterone, and the third, .5 mg megestrol acetate. These failure rates ranged from .6 to 1.2 ectopic pregnancies per 100 woman-years of use. There were 35 pregnancies among these women, 8.6% of which were ectopic. In another report, there were 3 ectopic pregnancies among 73 pregnancies. This proportion, 4.1%, was similar to that reported for pregnancies among IUD users. It was noted that side effects of progestogen-only contraception, e.g., spotting and breakthrough bleeding, lengthened cycle, and amenorrhea, are also symptoms of ectopic pregnancy. Physicians should consider ectopic pregnancy when patients are taking minipill contraceptives.     

Women's acceptance of an injectable progestin-only contraceptive in a free-choice environment in Turkey

A progestin-only injectable contraceptive has been integrated into the method mix at a well-woman clinic in Turkey. During the period from 1st December 1996 to 1st December 1997, among 3545 new method acceptors at the clinic, 254 women decided to use the injectable, giving an initial acceptance rate of 7%. Continuation rates, however, were quite low: 43.7% at 6 months and only 18.5% at 12 months. Though all the side-effects were mentioned during the counselling sessions, side-effects such as amenorrhea and spotting might have been underestimated by the potential users of this method, which was new in the country. A more detailed counselling with a strong emphasis on frequent side-effects might lower the initial acceptance rate, but can help to increase the continuation rates.     

Women's acceptance of an injectable progestin-only contraceptive in a free-choice environment in Turkey.

A progestin-only injectable contraceptive has been integrated into the method mix at a well-woman clinic in Turkey. During the period from 1st December 1996 to 1st December 1997, among 3545 new method acceptors at the clinic, 254 women decided to use the injectable, giving an initial acceptance rate of 7%. Continuation rates, however, were quite low: 43.7% at 6 months and only 18.5% at 12 months. Though all the side-effects were mentioned during the counselling sessions, side-effects such as amenorrhea and spotting might have been underestimated by the potential users of this method, which was new in the country. A more detailed counselling with a strong emphasis on frequent side-effects might lower the initial acceptance rate, but can help to increase the continuation rates.     

国产左炔诺酮硅胶棒Ⅱ型安全性3年临床观察

为观察国产左炔诺酮硅胶棒 型对妇女全身及生殖道的影响 ,对 31 5例皮埋者及30 2例健康妇女作连续 3年观察 ,测血压、体重、阴道 B超及宫颈刮片。结果皮埋对体重和血压无不良影响 ,皮埋组卵巢小囊肿的发生频率较高 ,但转经后复查均消失 ,属滤泡囊肿。子宫肌瘤的发生率 ,皮埋组低于对照组 ,而且多生长缓慢 ,基本保持原状。因此 ,皮埋是一种安全的避孕措施     

Clinical aspects of Ovulen application as a contraceptive and in gynecological disorders

57 women used the preparation Ovulen as a contraceptive for 2-7 cycles each (a total of 270 cycles). The preparation was observed to be 100% effective. Nausea and vomiting were observed in 3.7% of the users, spotting or abundant menstruation in 2.2%, painful swelling of the breasts in 1.1%, and acne in 1.0%. Cytohormonal smears and endometrial biopsy showed a weak progestational effect and high estrogenic activity. No disruptions of the blood sugar levels or thrombotic incidents were noted. Ovulen has been applied therapeutically in cases of functional dysmenorrhea, intermittent amenorrhea, and hypermenorrhea. It has been found useful in differential diagnosis of recent pregnancy vs. secondary amenorrhea. The possibility of thrombotic-embolic complications was stressed. An estrogen component of no more than .5 mg is recommended for progestagen drugs, so as to decrease the possibility of thrombotic complications. Ovulen was judged to be effective and well tolerated.     

Hysteroscopic appearance of the endometrial cavity following thermal balloon endometrial ablation

OBJECTIVE: To assess the appearance of the endometrial cavity after thermal balloon endometrial ablation. DESIGN: Observational study. SETTING: University teaching hospital. PATIENT(S): Twenty-two women who had undergone thermal balloon endometrial ablation and who were followed up for at least 6 months. INTERVENTION(S): Outpatient diagnostic hysteroscopy. MAIN OUTCOME MEASURE(S): Appearance of the endometrial cavity and presence of intrauterine adhesions on hysteroscopy. RESULT(S): Postablation intrauterine adhesions were found in eight women (36.4%); six had focal adhesions in the fundal area and two had complete obliteration of the cavity. Of these eight women, three had spotting during menstruation, three had hypomenorrhea, one had eumenorrhea, and one had amenorrhea. The uterine cavity was fibrotic in four (18%) women; all reported spotting during menstruation. Ten women had a normal uterine cavity; eight had hypomenorrhea, one had spotting, and one had eumenorrhea. CONCLUSION(S): The hysteroscopic appearance of the uterine cavity after thermal balloon endometrial ablation varies considerably. Menstrual outcome is associated with postablation appearance.     

Norplant皮下埋植五年七种月经异常的曲线拟合

本文报道了1000例Norplant皮下埋植者埋植五年内的月经异常情况.主要表现为经期延长、经量减少、点滴出血、月经过频、月经稀发、闭经及月经过多.用数学方法曲线拟合来表达,前六种月经改变随时间的推移呈双曲线型,3～6月时发生率甚高,在一年前后急速降至一较低水平,而后随时间的延长呈平缓下降的态势直至5年末.经量增多的发生与时间呈直线关系,两者为负相关.所有结果经F统计检验均有显著性差异(P<0.01).曲线拟合对该资料的分析的意义为:1.从理论上揭示了皮下埋植剂使用后月经常发生与时间的变化规律;2.能显示直观的印象;3.修匀散点图,减少抽样误差;4.通过曲(直)线方程,可对植入后各时点各种月经异常的发生率的大小作出估计,5.临床意义:临床医师可据此分析,在术前介绍情况和术后对象有月经异常主诉时,给对象讲述变化规律,描述发展前景,使对象有一定的心理准备,增强承受能力、增强信心,因而可一定程度地提高该避孕药使用的续用率.