不同剂量醋酸甲羟孕酮用于哺乳期妇女避孕的临床研究

目的 探讨不同剂量醋酸甲羟孕酮（DMPA）用于哺乳期妇女避孕对其避孕效果、副反应发生率及停用原因的影响。方法 将受试对象按剂量随机分为120mg和150mg两组,排除不符合研究标准者,纳入研究对象共计173例,120mg组87例,150mg组86例。每3个月深部肌肉注射1次,共4次。结果 两组避孕成功率均为100．00％;发生副反应中,点滴出血120mg组为6．90％,明显低于150mg组的16．28％（P＜0．05）。结论 120mg DMPA用于哺乳期妇女避孕不影响其有效性,且可减少副反应发生率。     

长效避孕针醋酸甲羟孕酮引入性试验

目的 评价醋酸甲羟孕酮避孕针在中国妇女中常规使用时的避孕有效率、续用率、副反应和可接受程度。方法 本研究为一开放临床随访试验,１９８５例自愿使用避孕针的妇女每３个月接受１次注射,随访１年。结果 １９８５例共使用醋酸甲羟孕酮２０７７２妇女月（１７３１．７妇女年）,１年累积续用率为７７．４％。避孕失败３例,生命表法１年累积失败率为０．２％。其他原因的１年累积停用率为闭经（４．８％）,与出血有关的问题（     

醋酸甲羟孕酮对恶性肿瘤诱导血管形成的抑制作用

醋酸甲羟孕酮对恶性肿瘤诱导血管形成的抑制作用谢守珍顾美皎程冀平姚茂湘曹亚莉１９７１年，Ｆｏｌｋｍａｎ［１］提出肿瘤的生长依赖于血管形成，血管形成后肿瘤迅速增长和转移。本研究旨在探讨醋酸甲羟孕酮（ＭＰＡ）抑制妇科恶性肿瘤诱导的血管生成作用及其机理，并分...     

含或不含醋酸甲羟孕酮的低剂量孕马雌酮对绝经早期妇女骨质的作用

为确定含或不含醋酸甲羟孕酮(MPA)的低剂量CEEs对绝经后妇女的髋骨及脊柱的骨密度,全身骨质以及骨转化率的生化指标的影响,1995年8月～2000年10月,美国19个中心进行2年随机双盲对照试验,研究对象为822例健康绝经后妇女,年龄为40～65岁,通过8组不同的剂量方案.即     

复方醋酸环丙孕酮治疗多囊卵巢综合征47例

多囊卵巢综合征（ＰＣＯＳ）引起的内分泌紊乱是导致不排卵的首位原因。对于无生育要求的ＰＣＯＳ患者,持续高水平的黄体生成素（ＬＨ）及睾酮（Ｔ）所致的排卵异常、月经紊乱及高雄激素征候群使治疗颇为棘手。现将我们应用复方醋酸环丙孕酮（复方ＣＰＡ）治疗的结果报道...     

醋酸环丙孕酮在妇女高雄激素血症中的应用

醋酸环丙孕酮具有抗雄激素，强孕激素活性，生物利用度高，消除半衰期长，对代谢的影响小。它在妇女高雄激素血症和多囊卵巢综合征中的应用值得重视。     

晚期卵巢恶性肿瘤术后辅助化学治疗及醋酸甲羟孕酮的临床观察

对恶性肿瘤的治疗现多采用大剂量联合化学治疗 (化疗 ) ,但常伴严重恶心、呕吐、食欲减退或完全丧失食欲 ,以及骨髓功能抑制等症状 ,因此被迫中断或停止化疗。 80年代后期 ,国外常用醋酸甲羟孕酮 (ＭＰＡ)治疗各种晚期肿瘤的厌食和恶液质 ,疗效肯定。本研究探讨晚期卵巢恶性肿瘤术后辅助化疗、ＭＰＡ的疗效及其可能机理。现报道如下。一、资料与方法1.资料来源及分组 :试验组为 1995年 5月至 1998年 7月我院及同济医院收治的 33例卵巢恶性肿瘤患者 ,术后均采用化疗联合ＭＰＡ治疗 ,其中卵巢上皮性癌 2 6例 ,恶性畸胎瘤 2例 ,内胚窦瘤 2例 ,…     

人子宫内膜癌耐醋酸甲羟孕酮细胞株的建立

目的建立人子宫内膜癌孕激素耐药细胞株Ishikawa（ISH）/醋酸甲羟孕酮（MPA）,为子宫内膜癌耐孕激素的发病机制提供基础。方法采用逐步递增MPA浓度方法进行Ishikawa细胞株耐药体外诱导。采用MTS法测定药物敏感性;绘制细胞生长曲线和计算群体倍增时间。结果 （1）成功建立了MPA诱导的人子宫内膜癌耐MPA细胞株ISH/MPA,其对MPA耐药指数为3.35;（2）ISH/MPA在含MPA 10μmol/L的培养基中的细胞倍增时间与Ishikawa在普通培养基中的倍增时间比较,差异无统计学意义（P〉0.05）,两者生长曲线比较一致。结论成功建立人子宫内膜癌MPA耐药细胞模型ISH/MPA细胞系,为进一步研究子宫内膜癌耐孕激素机制提供了基础。     

应用复方醋酸环丙孕酮治疗多囊卵巢综合征及合并耐氯Di酚不育的 …

目的 评估复方醋酸环丙孕酮（复方ＣＰＡ）治疗多囊卵巢综合征（ＰＣＯＳ）的疗效及安全性,探索葶药后改善促排卵效果的可行性。方法 ２９例ＰＣＯＳ患者「１６例为耐氯Ｄｉ酚（ＣＣ）或绝经期促性腺激素（ｈＭＧ）促排卵失败的无排卵性不育」,于自然月经或撤退性出血第５天服复方ＣＰＡ,共４～６个周期。服药前后观察临床表现、盆腔超声相、血清生殖激素、血脂水平的变化及副反应。停药后,耐ＣＣ的１２例再行ＣＣ促排卵２２个     

复方醋酸环丙孕酮联合安体舒通治疗PCOS不孕的疗效观察

目的探讨复方醋酸环丙孕酮(CPA)联合安体舒通治疗PCOS不孕的治疗效果.方法将96例PCOS不孕患者随机分成两组,实验组给予复方醋酸环丙孕酮1片/d,连续用21日,待撤退性出血第5天开始下一周期治疗,同时给予安体舒通40mg,每日2次.治疗前及治疗3个周期后用化学发光免疫检测FSH、LH、E2、PRL、T.实验组给予治疗3个周期后,对照组在完成各项检查后进行促排卵治疗.结果实验组治疗后,PCOS临床症状明显改善,LH水平明显降低,LH/FSH恢复正常,T水平明显降低,服药前后比较差异有非常显著性(P＜0.01).实验组周期排卵率、单卵泡发育率、妊娠率均显著高于对照组(P＜0.01).结论复方醋酸环丙孕酮联合安体舒通治疗PCOS不孕患者,可改善患者的高雄激素征候群,使多数患者内分泌失调状态调至正常水平,提高促排卵的排卵率及临床妊娠率.     

Intrauterine Contraception Continuation in Adolescents and Young Women: A Systematic Review

Study ObjectiveAdolescents are at high risk for unintended pregnancies. Although intrauterine devices (IUDs), long-acting reversible contraceptives (LARCs), are known to be highly effective in preventing pregnancy, little is known about IUD adherence in adolescents. In this systematic review (SR) we examined IUD continuation rates compared with other forms of contraception in young women aged 25 years and younger.Design, Setting, Participants, Interventions, and Main Outcome MeasuresA systematic search of Ovid Medline, Cochrane Library, and Embase was conducted for the years 1946-2015. Included studies examined IUD use in women 25 years of age and younger, compared IUD use with another form of contraception, and measured continuation rates at 12 months. The quality of each study was appraised using the Downs and Black criteria, and 12-month continuation rates among studies were pooled and analyzed according to contraceptive type.ResultsOf 3597 articles retrieved, 9 studies met criteria for SR. Synthesized across studies, 12-month continuation was significantly higher for IUD users (86.5%, 12,761/14,747) compared with oral contraceptives (39.6%, 1931/4873), Depo-Provera (Pfizer Inc, New York, NY) hormonal injection (39.8%, 510/1282), vaginal ring (48.9%, 196/401), and transdermal patch (39.8%, 37/93; all P values < .001). There was no statistically significant difference in 12-month continuation between the IUD and another LARC method, the subdermal etonogestrel implant (85.3%, 4671/5474).ConclusionFindings of this SR suggest that continuation rates for IUDs are generally higher compared with other contraceptive methods for women aged 25 years and younger. In a population with high rates of unintended pregnancies, generally low adherence, and imperfect use with other non-LARCs, IUD use should be encouraged.     

使用国产长效避孕皮下埋植剂妇女第一年血清中左旋18甲基炔诺酮、雌二醇及孕酮水平

10例妇女在月经周期开始的7天内,皮下埋植国产长效避孕埋植剂。埋植后第一年内每周定时抽血一次,用RIA 测定血清中左旋18甲基炔诺酮(LNG),雌二醇(E_2)和孕酮(P)的浓度。血清中LNG 浓度在埋植后开始两周内下降较快,随后两周较缓慢地下降,在埋植后第一年内LNG 浓度几乎呈平稳状态,但显示有明显的个体差异。血清中E_2峰值频繁出现,但随后未见典型的黄体期P 值升高,在高的E_2峰值突然下降时,常伴随阴道流血出现。干扰月经是此埋植剂的主要副反应。     

Young women's attitudes towards,and experiences of,long-acting reversible contraceptives

Abstract

Objectives To identify factors involved in women's decisions to choose particular contraceptive methods and more specifically, incentives and disincentives to use three long-acting reversible contraceptive (LARC) methods: injectables, implants, and intrauterine devices/systems (IUDs/IUSs).

Methods A total of 502 women aged 18 to 30 completed a cross-sectional online questionnaire.

Results The three most important factors in choosing a contraceptive method were: high efficacy at preventing pregnancy, protection against sexually transmitted infections, and non-interference with sexual intercourse. The most common incentives for LARC use were the high efficacy and long duration of action. Disincentives included the possibility of irregular bleeding and concerns about effects on fertility; fear of needles and pain was a particular disincentive for IUD/IUS use. Only 93 (18%) of the participants reported ever having used a LARC.

Conclusions Reported disincentives to LARC use (e.g., concern about effects on future fertility) indicated that many young women hold inaccurate beliefs about these methods. The relatively high proportions of women who held neutral attitudes about LARCs (21–40%, depending on the method) highlight the importance of education and contraceptive counselling to improve knowledge about the advantages of these methods.

Chinese Abstract

摘 要目的 了解女性选择避孕方法的影响因素和应用三种长效可逆避孕方法（LARC）：注射避孕针、埋植剂和宫内节育器/宫内系统(IUDs / IUSs)的有利和不利因素。

方法 502名18～30岁女性完成了横断面在线问卷调查。

结果 在选择避孕方法的三个最重要的影响因素是：防止妊娠的高效性,预防性传播感染和不干扰性交。LARC使用最常见的有利因素是高效和长效性。不利因素包括不规则出血的可能性和对生育影响的担忧;对针和疼痛的恐惧是选用IUDs / IUSs 的不利因素。只有93（18%）的女性曾经使用过LARC。

结论 应用LARC的不利因素（如对将来生育影响的担忧）表示许多年轻女性对这些方法存在错误的观点。对LARCs持有中立态度的女性占相对较高的比例（21–40%）,提示教育和避孕咨询的重要性,以提高对这些方法优点的认识。     

哺乳妇女单次注射迪波盖司通~长效避孕针后血清和乳液中MPA浓度变化

目的:探讨中国妇女哺乳期使用迪波盖司通后血清和乳液醋酸甲羟孕酮(MPA)浓度变化。方法:10名产后哺乳妇女单次注射迪波盖司通(含MPA150mg),在注射后的第1、2、4、6、8、10和12周采集血样和乳液样本,用放射免疫方法测定MPA。结果:血清MPA浓度于注射后第1周最高,到第2、4周时下降明显,第4周后浓度下降趋势逐渐缓慢。乳液MPA浓度在第1周为最高,第2周比第1周降低了约1/2,之后10周平均浓度变化波动在5.09-8.15ng/ml之间。观察期间乳液/血清MPA浓度比值和曲线下浓度面积比值均为0.55。对象之间和同一对象不同时间点乳液/血清MPA浓度存在明显个体差异。结论:哺乳期使用迪波盖司通,将导致血液和乳液中含有一定量的MPA。     

Scoping Review on the Use of Early Warning Trigger Tools for Women in Labor

ObjectiveTo identify existing obstetric trigger tools, evaluate their sensitivity and specificity to correctly identify women in need of care escalation, and describe clinicians’ experiences of using these tools while caring for women in labor.Data SourcesIterative searches of three databases, CINAHL, PubMed, and SCOPUS, in October 2019 and June 2020 using the keywords maternal surveillance system, obstetric1, early warning scores, early warning systems, and trigger tools.Study SelectionPrimary quantitative and qualitative studies on the utility or implementation of trigger tools for women in labor that were written in English. Through the initial search, I identified 208 articles and included 11 full-text articles in this review.Data ExtractionI extracted data related to aims, population, methodology, outcomes, and key findings for each study and entered them into a matrix based on the Joanna Briggs Institute Review Guidelines.Data SynthesisQuantitative researchers found that the sensitivity and specificity to correctly identify women in need of care escalation of tools varied and recommended that institutions should consider the burdens of false positives versus the risks of false negatives when choosing a tool for their contexts. Qualitative researchers described clinicians’ experiences with the use of trigger tools and systems-level barriers to implementation, including lack of training, poor management of implementation, increased workload due to redundant charting, and belief that tools were not appropriate for women with low-risk pregnancies. Greater rates of false positives led clinicians to use trigger tools only for women with high-risk pregnancies rather than as a screening tool for all women.ConclusionTrigger tools may help with early identification of worsening clinical condition, but further research is needed to refine and improve tools, as well as understand best practices for tool implementation. Systems-level factors should be considered in tool selection.     

国产两根型皮埋剂对人体脂蛋白代谢及HDL_2-C水平的影响

本文观察２０例健康育龄妇女皮下埋植Ｓｉｎｏ－ｉｍｐｌａｎｔ１２个周期中脂蛋白、载脂蛋白代谢及ＨＤＬ２Ｃ水平的变化。结果显示：Ｓｉｎｏｉｍｐｌａｎｔ埋植后,各项脂质、脂蛋白及载脂蛋白的水平与植入前比较均有不同程度的下降,其中甘油三酯（ＴＧ）及载脂蛋白ＡＩ（ａｐｏＡＩ）水平在不同的观察周期均下降显著（Ｐ＜０．０５）,至第１２周期时该两水平有回升趋势。ＨＤＬ２Ｃ水平未见有显著改变,但ＨＤＬ２Ｃ水平明显下降,尤其在第３、１２周期时有显著差异（Ｐ＜０．０５）。结果表明：Ｓｉｎｏｉｍｐｌａｎｔ具有降低ＴＧ、ａｐｏＡＩ、ＨＤＬ２Ｃ水平作用,然而该变化随着药量释放的减少和恒定渐趋恢复,况且Ｓｉｎｏｉｍｐｌａｎｔ降低ＨＤＬ２Ｃ的机理可能不同于冠心病患者的低ＨＤＬ２Ｃ水平的发生机理。因此本研究认为Ｓｉｎｏｉｍｐｌａｎｔ对人体脂蛋白代谢无明显不良副作用。     

Implanon: A Review of the Literature With Recommendations for Clinical Management

Implanon is a new implantable, progestin‐only contraceptive which was approved in the United States in July 2006. Implanon is comprised of a single ethylene vinylacetate copolymer rod that is 4 cm long and 2 mm in diameter. It is inserted subdermally in the groove between the biceps and triceps of the nondominant arm. A literature review was conducted and side effects are discussed. Implanon offers promise as a high‐efficacy, long‐term contraceptive and can enhance the contraceptive options offered by the women's health care providers. Clinical trial data indicate that the device is both safe and effective.     

左炔诺孕酮T形宫内节育器治疗子宫腺肌病46例分析

目的:探讨宫腔内放置含左炔诺孕酮的T形宫内节育器(曼月乐)治疗子宫腺肌病的疗效。方法:选择46例患子宫腺肌病的已育妇女,选择月经周期第5~8天放置左炔诺孕酮T形宫内节育器。分别在放置前、放置后3个月、12个月观察其月经量、血红蛋白、痛经、子宫体积及血清中FSH、LH、E2水平的变化。结果:放置左炔诺孕酮T形宫内节育器后,患者的月经量较放置前明显减少(P<0.01),18例患者出现时间长短不等的闭经;血红蛋白较放置前无明显增加(P>0.05);痛经明显减轻(P<0.01);子宫体积较放置前明显缩小(P<0.05);血清FSH、LH、E2水平较放置前无明显变化(P>0.05)。结论:宫腔内放置左炔诺孕酮T形宫内节育器能明显减轻患者的临床症状,对卵巢功能无明显影响,能有效地提高患者的生活质量,有很好的临床应用价值。     

中国四城市医院未婚人流女青年生殖道感染状况研究

目的:了解未婚人流女青年生殖道感染/性传播疾病(RTIs/STIs)的患病率、性暴力的发生率及其相关的影响因素;了解未婚人流女青年性和生殖健康知识、态度、行为和生殖健康保健需求。方法:2002.10-2003.02期间,广东省深圳市、广西省南宁市、北京市、河南省郑州市的市级医院妇产科对2002名年龄<24岁来院要求人工流产的未婚女青年进行妇科检查和实验室检查及自填式问卷调查。结果:调查对象平均年龄为22.0±1.7岁,流动人口占61.0%。在调查中生殖道感染的患病率为57.1%,性传播疾病的患病率是9.8%。与生殖道感染有关的影响因素包括非流动人口、首次性行为年龄≤19岁、未使用避孕方法、既往有患RTIs病史、清洁外阴间隔时间≥2d。调查对象性暴力的发生率是11.7%。首次性行为的平均年龄为20.3±1.9岁。平均拥有性伴侣数为1.2±0.9个。生殖健康知识总分平均为4.2±2.3分(总分9分)。调查对象对生殖健康保健知识的需求依次为避孕知识、人工流产危害、性生理知识、性传播疾病的危害与预防等。结论:未婚人流女青年有关性和生殖健康知识贫乏;首次性行为平均年龄提前;RTIs/STIs是未婚人流女青年生殖健康的主要问题;未婚人流女青年中的性暴力现状不容忽视。