丙泊酚配伍米索前列醇用于人工流产镇痛效果观察

目的:探讨无痛人工流产术前应用米索前列醇对宫颈的扩张效果。方法:将330例自愿要求行无痛人工流产术终止妊娠的早孕健康妇女随机分为观察组(A组)和对照组(B组)。A组于手术前3h口服米索前列醇0.2～0.4mg,然后在丙泊酚静脉麻醉下行人工流产手术;B组直接在丙泊酚静脉麻醉下行人工流产手术,观察两组宫颈扩张、手术时间、术中出血量、术后阴道流血时间、用药量及用药后副作用。结果:两组手术麻醉效果无显著差异(P<0.05)。但A组宫颈松弛度明显好于B组,手术时间A组也较B组明显缩短,且手术易于操作,术中出血量、术后阴道流血时间均明显少于B组,丙泊酚用药量减少(P<0.01)。两组均无人工流产综合症及无一例呼吸抑制发生。结论:丙泊酚静脉麻醉下实施人工流产,术前3h口服米索前列醇0.2～0.4mg,有较好的宫颈扩张作用,可增强子宫收缩,手术易于操作,术中出血少,术后阴道流血时间短,丙泊酚用量减少,值得临床推广应用。     

丙泊酚联合芬太尼、米索前列醇在人工流产中的临床观察

目的：观察丙泊酚联合芬太尼、米索前列醇在人工流产中的应用效果。方法：将100例早孕妇女随机分为观察组和对照组各50例,观察组用丙泊酚静脉麻醉联合芬太尼、阴道后穹窿放置米索前列醇,对照组仅用丙泊酚。观察人流术中两组的镇痛效果、宫口松弛度,手术时间、术中出血量及丙泊酚的用量、不良反应及并发症。结果：丙泊酚联合芬太尼、米索前列醇用于人工流产镇痛有效率100%,宫颈软化率高,手术时间短,丙泊酚用量少,术中及术后出血少。结论：丙泊酚联合芬太尼、米索前列醇用于人工流产无痛效果肯定,不良反应少。     

米索前列醇联合笑气在人工流产中的应用

为了减少人工流产受术者的痛苦，本文就2002年6月-2003年6月在本院门诊要求行人工流产的320例早孕初孕妇，采用米索前列醇联合笑气镇痛，取得满意效果，现报道如下。     

斯帕丰联合米索前列醇用于人工流产镇痛的临床观察

人工流产是避孕失败导致意外妊娠的常用补救措施之一。目前临床上除了少部分选择无痛流产术外,多数于术前应用镇痛或扩张宫颈的药物以减轻疼痛和减少人工流产并发症。2005年1月至10月,我们采用在人工流产术前应用斯帕丰(Phloroglucinol Injection,通用名:间苯三酚注射液)联合米     

米索前列醇用于无痛人工流产的临床观察

目的:观察米索前列醇用于无痛人工流产术的临床效果。方法:将米索前列醇在无痛人工流产术前、后舌下含化,并与无痛人工流产术、一般人工流产术对比。观察镇痛效果、宫颈松弛度、手术时间、术中出血量及人工流产综合反应发生率、不良反应等指标。结果:米索前列醇应用于无痛人工流产手术前后,镇痛率100%,宫颈松弛软化率高,缩短了手术时间,减少了术中出血量,有效地避免了人工流产综合反应的发生,不良反应轻微。结论:米索前列醇用于无痛人工流产,能充分改善宫颈松弛度,缩短手术时间,减少手术中的出血量。此法简单易行、效果好、副反应少。     

米非司酮配伍米索前列醇用于人工流产术前的效果分析

目的评价米非司酮配伍米索前列醇用于早孕8～12周人工流产术前对宫颈的松弛效果。方法将要求无痛人工流产的健康早孕妇女分为两组，试验组术前应用米非司酮150mg及米索前列醇400μLg，然后在异丙酚静脉麻醉下行人工流产手术；对照组直接行异丙酚静脉麻醉下人工流产手术，对两组进行多项指标对比分析。结果试验组宫颈松弛度明显好于对照组，手术时间也较对照组明显缩短，且手术易于操作，术中出血少。两组均无人工流产综合征发生。结论米非司酮配伍米索前列醇用于无痛人工流产术前，有较好的宫颈松弛作用，手术易于操作，术中出血少，值得临床应用。     

米索前列醇联合杜冷丁异丙嗪用于712例人工流产的疗效观察

目的:探讨米索前列醇联合杜冷丁和异丙嗪在人工流产术中应用的临床效果。方法:选择我院2008年12月至2011年01月901例自愿要求做无痛流产的妇女,均为未生育的初孕女性,随机分为两组,试验组(n=712)术前2小时口服米索前列醇600ug,术中静脉推注杜冷丁和异丙嗪后行手术。对照组(n=189)不用任何药物直接进行手术。结果:试验组镇痛效果优于对照组,降低了人工流产综合征,并且缩短了手术时间,不增加阴道流血。结论:杜冷丁和异丙嗪联合米索前列醇在人工流产术中镇痛效果好,应用方便,值得临床推广使用。     

米索前列醇在人工流产术中扩张宫颈的临床观察

<正>为了探索米索前列醇(以下简称米索)在人工流产术中扩张宫颈的临床效果,我们对198例要求行人工流产的孕6～13周健康妇女给予口服米索行药物扩宫,观察结果如下.     

米索前列醇在早期人工流产术中的应用

本文前瞻性地于人流术前口服米索前列醇作药物扩宫共５１例，与对照组５０例结果相对照。确诊早孕后口服米索前列醇２００μｇ，每日４次，共２天，服完末次药后１～３小时作吸宫人流术，研究组人流时宫颈变软，松弛可入６～７．５号宫颈扩张器者共４３例，总有效率为８４．３１％，对照组占３８％，Ｘ＾２检验Ｐ〈０．０１，差异非常显著，结果认为口服米索前列醇，可使宫颈变软，宫口松弛，是一种简便，安全，有效的药物扩宫法。     

间苯三酚联合米索前列醇用于人工流产50例临床分析

目的:探讨间苯三酚联合米索前列醇用于人工流产术中的临床疗效及其安全性。方法:150例早孕妇女分为观察组、对照组和空白对照组各50例,观察组术前使用间苯三酚联合米索前列醇;对照组术前单纯使用米索前列醇;空白对照组术前不用药,观察3组的临床效果。结果:观察组和对照组比较在缓解疼痛方面差异有统计学意义(P<0.05);在降低胃肠道反应及体动的发生方面差异有高度统计学意义(P<0.01);宫口扩张、术中出血等相比观察组和对照组差异无统计学意义(P>0.05),观察组与空白对照组比较,镇痛效果、宫口扩张情况、术中出血量、不良反应经统计学分析,差异均有统计学意义(P<0.05)。结论:间苯三酚联合米索前列醇用于人工流产镇痛效果好,不良反应少,安全,简单,费用低,适于推广。     

芬太尼和氯胺酮分别用于无痛人流术效果观察

目的 :探讨芬太尼和氯胺酮用于无痛人流手术效果及副作用情况。方法 :芬太尼 0 .0 0 2mg/ kg、氯胺酮 0 .3mg/ kg分别用于人流镇痛各 1 0 0例 ,并设立不用止痛药物的 1 0 0例作为对照组 ,监测镇痛效果、HR、RR、BP、Sp O2 、出血量、副作用等。结果 :芬太尼组人流无痛率达 84%、轻痛率为 1 5% ;氯胺酮组人流无痛率达 76 %、轻痛率为 2 2 %。而对照组 72 %疼痛难忍。两无痛组用药前后 HR、RR、BP、Sp O2 平稳 ,出血量与对照组相比无增加 ,无人流综合征发生。而对照组发生率为 1 3%。结论 :两种药物用于无痛人流术均较理想 ,芬太尼较氯胺酮更为安全     

米非司酮配伍米索前列醇治疗稽留流产的疗效分析

目的 探讨米非司酮配伍米索前列醇治疗稽留流产的临床疗效.方法 选取66例稽留流产患者,采用随机数字表法分为对照组与试验组,各33例.对照组给予米非司酮50 mg治疗3 d后配伍米索前列醇600 μg治疗,试验组给予米非司酮50 mg治疗1d后,增加75 mg米非司酮用药1 d后配伍米索前列醇600 μg治疗.比较两组临...     

双异丙酚联合芬太尼在人工流产术中的应用

目的 探讨应用双异丙酚联合芬太尼在人工流产术中的镇痛效果及宫颈扩张作用。方法 选择要求终止妊娠的早孕妇女300例，随机分为2组，分别在人工流产术时单独应用双异丙酚及双异丙酚联合芬太尼。观察术中镇痛效果、扩宫的难易程度、手术时间及手术并发症。结果 联合应用组的宫颈完全松弛率均明显大于单独应用双异丙酚组（P〈0．01），术中不良反应少（P〈0．01）；无痛率明显大于双异丙酚组（P〈0．01）。结论 双异丙酚联合芬太尼能有效提高手术质量，减少并发症。     

Laminaria, induced fetal demise and misoprostol in late abortion.

OBJECTIVES: To analyze and determine the safety and effectiveness of induced fetal demise as an adjunctive method in outpatient abortion for patients with advanced pregnancies and to evaluate the independent effect of intrauterine misoprostol administered after amniotomy in late abortion. METHODS: During a 9-year period, 1677 abortions were performed for patients whose pregnancies ranged from 18 through 34 menstrual weeks in an outpatient facility. Of these, 832 were performed by one physician. Techniques for performing all the abortions included induction of fetal demise by intrauterine fetal injection of digoxin and/or hyperosmolar urea, serial multiple laminaria treatment of the cervix, amniotomy, oxytocin induction of labor, and assisted delivery or surgical evacuation of the fetus and placenta. In the last 411 of the 832 patients whose abortions were performed by one physician, misoprostol was placed in the lower uterine segment following amniotomy in order to enhance labor induction, cervical ripening, and fetal expulsion. RESULTS: Of the entire group of 1677 cases, the median gestational age was 22 menstrual weeks. The median procedure time for all cases was 10 min. Measured median blood loss was 125 ml. Blood loss and procedure time increased with length of gestation, but these were not affected by misoprostol. There were three major complications (0.2%) in the overall series. Among patients seen by one physician (N=832), amniotomy-to-procedure time was shorter by 26 min for patients receiving misoprostol, and there was 27% more variability in amniotomy-to-procedure time among patients not receiving misoprostol. Complication rates for patients receiving misoprostol were the same as for those not receiving misoprostol. There were no major complications in the 832 patients seen by one physician, no uterine rupture or perforations, and no cervical lacerations. CONCLUSIONS: Outpatient abortion may be performed safely from 18 through 34 menstrual weeks using combined surgical and medical procedures. Use of intrauterine post-amniotomy misoprostol was associated with reduced amniotomy-to-procedure time and reduced variability in the amniotomy-to-procedure time.     

中医药防治米非司酮配伍米索前列醇抗早孕药物流产副反应的研究概况

米非司酮配伍米索前列醇抗早孕在临床上已得到广泛应用,但是药物流产后的近期副反应及其可能带来的严重并发症是我们不能忽视的。中医药在防治药物流产后副反应方面的疗效已得到认可。目前针对中医药防治药物流产后副反应的研究主要集中于临床研究,包括病因病机、临床研究方法等方面;其中,临床研究方法主要可分为中药、针灸和针药并用3种。但是对于其机制研究及中药疗效机理等方面的研究却相对缺乏。今后需进一步深入研究,使中医药在防治药物流产后副反应发挥更大的作用。     

Early medical abortion with methotrexate and misoprostol

OBJECTIVE: To evaluate the introduction of an early medical abortion program with methotrexate and misoprostol, using a standardized protocol. METHODS: A total of 1973 women at 34 Planned Parenthood sites participated in a case series of early medical abortion. Ultrasound was used to confirm gestational age of less than 49 days from the first day of the last menstrual period. Women were given intramuscular methotrexate 50 mg/m(2) of body surface area on day 1, and then they inserted misoprostol 800 microg vaginally at home on day 5, 6, or 7. Women were advised to have a suction curettage if the pregnancy appeared viable 2 weeks after methotrexate or if any gestational sac persisted 4 weeks after methotrexate. Outcomes were complete medical abortion and suction curettage. RESULTS: Sixteen hundred fifty-nine women (84.1%) had a complete medical abortion, and 257 (13.0%) had suction curettage. The most common reason for curettage was patient option (8.9%). At 2 weeks after methotrexate use, 1.4% of women had curettage because of a viable pregnancy; at 4 weeks, 1.6% of women had curettage because of a persistent but nonviable pregnancy. One percent of women had curettage because of physician recommendation, most commonly for bleeding. Suction curettage rates decreased with site experience (P <.006) and were lower at early gestational ages (P <.004) and in nulliparous women (P <.004). CONCLUSION: Medical abortion with methotrexate and misoprostol is safe and effective and can be offered in a community setting.     

Uterine rupture during second trimester abortion with misoprostol

BACKGROUND: Data are limited regarding the use of misoprostol in the midtrimester, therefore few cases with uterine rupture during the second trimester with a previous uterine scar have been reported in the literature. CASE REPORT: A 23-year-old woman with a prior low transverse cesarean section presented at 26 weeks' gestation for pregnancy termination for a fetal abnormality. She was given 200 microg misoprostol intravaginally every 3 h until regular contractions began. After the fourth dose, she had vaginal bleeding and severe contractions. She aborted completely 2 h later after the last dose. Uterine rupture was diagnosed at the previous cesarean section scar by manual vaginal examination. She underwent emergency laparotomy and the uterus was repaired. CONCLUSION: Misoprostol use in the second trimester in a woman with a uterine scar can trigger severe contractions that can lead to uterine rupture.     

Decentralizing postabortion care in Senegal with misoprostol for incomplete abortion

Objective

To expand access to postabortion care (PAC) services in Senegal by introducing misoprostol as a first-line treatment at the community level.

Methods

The present prospective study enrolled 481 women seeking treatment for incomplete abortion at 11 community health posts in Senegal between September 2011 and August 2012. Participants were given 400 μg of sublingual misoprostol and asked to return to the clinic 1 week later to confirm clinical status. At study completion, all women were asked to respond to a series of questions regarding their experience with this method. All care was provided by nurse midwives.

Results

All but three of the study women (99.4%; 474/477) had successful complete abortion after taking misoprostol. Almost all women were satisfied or very satisfied with the treatment (99.6%; 469/471), would select the method again if needed (98.9%; 465/470), and would recommend the method to a friend (99.8%; 468/469).

Conclusion

The results provide further evidence that 400 μg of misoprostol is highly effective for first-line treatment of incomplete abortion. Furthermore, this regimen can be fully provided by nurse midwives, and can be easily and successfully introduced in community health settings where other methods of PAC may not previously have been available. Clinicaltrials.gov: NCT01939457