米非司酮加倍给药用于终止早孕的临床效果观察

目的:探讨米非司酮配伍米索前列醇终止早孕最佳剂量方案。方法:将600例早孕,且孕囊平均直径≤25mm,要求药物终止妊娠的妇女,随机分为对照组和观察组各300例。对照组第1、2天上午服米非司酮50mg,12h后服25mg,总剂量150mg,第3天晨服米索前列醇600μg,4h后服400μg,总量1000μg。观察组米非司酮首次剂量50mg,继后每12h服25mg(共6天),总剂量300mg,第3天晨服米索前列醇600μg,第4～6天晨各服200μg,总量1200μg。结果:完全流产率对照组94.3％,观察组92.5％(P>0.05)。出血时间对照组13.6±6.84天,观察组13.3±7.08天(P>0.05)。孕囊排出时间、转经间隔时间和经期均相似。结论:米非司酮配伍米索前列醇加倍给药不能改善药物流产结局。     

米非司酮配伍米索前列醇联合己烯雌酚终止12~24周妊娠的临床探讨

目的探讨终止12~24周妊娠最佳药物流产方法。方法观察组用己烯雌酚、米非司酮、米索前列醇联合终止12~24周妊娠,对照组用米非司酮配伍米索前列醇终止12~24周妊娠,两组进行比较。结果观察组成功率100%,宫缩开始时间(0.57±0.24)h,胚胎/胎儿排出时间(7.22±4.91)h,产时出血量(148.99±58.94)ml,恶露干净时间(14.8±7.8)d。对照组成功率92%,宫缩开始时间(0.63±0.37)h,胚胎/胎儿排出时间(9.21±1.96)h,产时出血量(148.99±58.94)ml,恶露干净时间(18.6±9.0)d,两组差异具有显著性(P<0.05)。结论己烯雌酚、米非司酮、米索前列醇联合用药终止12—24周妊娠是安全、可靠、成功率较高,是基层医院采用的一种理想药物流产方法。     

米非司酮配伍米索前列醇终止10~14周妊娠的临床观察

目的:观察米非司酮配伍米索前列醇终止10~14周妊娠的临床效果。方法:将86例10~14周妊娠孕妇随机分为观察组和对照组,每组各43例。观察组米非司酮75 mg/d顿服,连服2 d,第2 d服药后24 h服米索前列醇600μg,服药前后2 h禁食,冷开水送服,并计算引产时间;对照组宫腔内羊膜腔外注射含利凡诺100 mg的水溶液50 m l,同时计算引产时间。两组均观察20 h,观察其妊娠物排出时间、阴道出血量、副作用及月经复潮情况。结果:观察组完全流产率、平均妊娠物排出时间及出血量明显优于对照组(P<0.05),差异具有显著性。结论:米非司酮配伍米索前列醇终止10~14周妊娠的流产方法各种并发症较少,更安全、简单、有效、可行。     

米非司酮配伍米索前列醇终止16~24周妊娠临床多中心研究

目的:探索米非司酮配伍米索前列醇终止16~24周妊娠的最佳给药方案。方法:将来自上海市8所医院607例要求终止16~24周妊娠的妇女随机分为3组。组I第1天晨口服米非司酮200mg,第3天晨阴道放置米索前列醇400μg,12h重复1次,最多3次;组II第1天晨口服米非司酮100mg,连用2d,第3天阴道放置米索前列醇400μg,使用方法同组I;组III第1天晨口服米非司酮200mg,第3天晨口服米索前列醇400μg,每6h重复1次,最多4次。结果:3组流产成功率分别为97.1%、96.0%和92.0%,差异有统计学意义(χ2=6.05,P=0.048);流产成功577例,引流产时间为13.43±10.18h,3组间无统计学差异(F=1.01,P=0.36);流产成功者中,米索前列醇用量组I、组II、组III分别为616.33±317.26μg、634.99±307.88μg、797.85±395.56μg,组III使用量高于组I、组II(F=16.20,P=0.00)。胎儿娩出后2h内和2~24h阴道流血量3组差异均无统计学意义。用药后主要不良反应为胃肠道不适,程度轻且无需特殊处理。结论:单次口服米非司酮200mg配伍米索前列醇,每12h阴道给药400μg,是终止16~24周妊娠的理想用药方案。     

小剂量米非司酮胶囊配伍米索前列醇终止早孕的临床研究

目的:观察小剂量米非司酮胶囊(75mg)配伍米索前列醇终止早期妊娠的效果。方法:共纳入120例自愿终止妊娠的孕妇(≤7孕周),采用米非司酮75mg分次口服,第3天顿服米索前列醇600μg的方案,分析临床效果。结果:完全流产率91.67%(110/120),不全流产率6.66%(8/120),继续妊娠率1.67%(2/120);1.7%(2/120)服用米非司酮胶囊后孕囊即排出,75.0%(90/120)服用米索前列醇后孕囊排出,23.3%(28/120)观察期间未见孕囊排出;平均孕囊排出时间为2.77h,流产6h内阴道流血量43.4ml,无一例输血或应用止痛药。随访发现药物流产后阴道流血时间12.2±7.7d,其中点滴出血时间8.1±7.3d;药物流产后至第1次月经复潮的时间35.8±9.1d。受试者对米非司酮和米索前列醇的药物耐受性较好,无严重不良事件发生,各种副反应无须特殊处理。结论:75mg米非司酮胶囊配伍米索前列醇600μg终止≤49d早期妊娠具有较好的临床效果,建议开展较大规模的随机对照临床试验进一步验证。     

丙酸睾丸酮配伍米非司酮、米索前列醇药物终止10～16周妊娠的临床观察

目的 观察丙酸睾丸酮配伍米非司酮、米索前列醇药物终止10 ～16周妊娠的临床疗效.方法 本院200例妊娠10～16周孕妇要求终止妊娠者,经过B超及相关检查确诊后,无药物禁忌证.将流产者按药物流产方案不同分实验组和对照组,每组100例.实验组给予肌注丙酸睾丸酮注射液100mg,1次/d,连用3d,在第2天肌注丙酸睾丸酮的同时口服米非司酮片25mg,每12小时1次,连服3d,第5天早晨空腹口服米索前列醇片400μg,于阴道后穹窿放置200μg,对照组口服米非司酮250mg,1次/12h,连用3d,第4天空腹口服米索前列醇片600μg,观察服药期间副作用、阴道流血、宫颈扩张、宫缩及胎儿组织排出情况.结果 出血时间早,宫颈完整松驰、扩张,流产时间短;完全流产率高;药物服用方便,副反应小,患者乐于接受;诱发子宫收缩缓和;降低了单纯服用米非司酮及米索前列醇的失败率;补充了利凡诺小月份引产羊膜腔不易穿刺成功的缺点;费用低便于开展工作.结论 丙酸睾丸酮配伍米非司酮、米索前列醇可以代替创性损伤可能性大的羊膜腔穿刺引产术,钳刮术及清宫术用于孕10～16周妇女终止妊娠,是一种安全、有效、实用的流产方法,值得进一步开展.     

米非司酮与米索前列醇用于终止11~16周妊娠的临床效果观察

目的:观察宫腔内注射依沙丫啶配伍米非司酮或米索前列醇终止11~16周妊娠的效果。方法:将来本院自愿要求终止11~16周妊娠的健康妇女469例,随机分为A组单纯应用依沙吖啶,108例;B组依沙吖啶配伍米非司酮,117例;C组依沙吖啶配伍米索前列醇,125例;D组米非司酮配伍米索前列醇,119例。结果:B、C、D组引流产成功率高于A组(P<0.05)。C组引流产时间短于A、B、D三组,而D组引流产时间较A、B、C组长且不良反应发生率高(P<0.05)。结论:米索前列醇和米非司酮可提高依沙吖啶引流产效果,且与米非司酮配伍米索前列醇引流产的成功率相似,同时可缩短引流产时间,减少米索前列醇剂量,降低了药物的不良反应。     

米非司酮合并米索用于中期引产两种方法比较

为观察米非司酮配伍不同剂量米索前列醇用于中期引产的效果,对60名孕12～20周妇女随机分别予以口服米非司酮200mg后,或配伍米索单次阴道给药,或配伍米索重复阴道给药,行中期引产。结果两组引流产成功率均为100％。米索单次及重复阴道给药在引流产时间,引流产率方面无显著性差异,重复给药副作用明显增加。结论:口服米非司酮200mg配伍米索600μg单次阴道给药,是一种终止12～20周妊娠的理想方法。     

米非司酮、丙酸睾丸酮分别配伍卡孕栓及米非司酮配伍米索前列醇终止10～16周妊娠的随机对比研究

148例10～16周妊娠妇女,按随机表分为A、B、C三组。A组:米非司酮配伍卡孕栓;B组:丙酸睾丸酮配伍卡孕栓;C组:米非司酮配伍米索前列醇。结果:米非司酮配伍卡孕栓组终止妊娠成功率为100％,平均引流产时间为7.78±1.02h;丙酸睾丸酮配伍卡孕栓终止妊娠成功率为89.8％,平均引流产时间为10.69±0.81b;两组之间差异显著(P<0.05)。卡孕栓用量,A组平均3.63±0.19mg,B组平均4.49±0.13mg,两组之间差异非常显著(P<0.01)。米非司酮配伍米索前列醇终止妊娠成功率为88％,和A组相比差异显著(P<0.05),平均引流产时间为9.64±1.89h,与A、B两组相比无显著差异。结论:米非司酮配伍卡孕栓用于终止10～16周妊娠效果明显优于其它两组,可为终止此期妊娠的较理想方法。     

单独应用米索前列醇终止早孕

本文对8项研究进行回顾性研究,讨论单用米索前列醇终止早孕的效果及存在问题。 8项中仅1项对单独口服米索前列醇与米非司酮配伍米索前列醇终止早孕的疗效进行了对比,结果前者成功率仅5％。另7项均使用阴道单独放置米索前列醇终止早孕,分述如下:①比较氨甲喋呤配伍米索前列醇与单用米索前列醇终止≤56 d妊娠的效果。后者首次剂量800 μg,未流产者24 h后重复给药,治疗开始后14 d测定成功率,结果其效果不如前者。②两种单用米索前列醇方法终止孕5～7周和孕8～11周妊娠。第1组200μg/12 h×4,第2组400 μg/12 h×4。治疗48h不全流产或阴道出血过多则手术终止。5～7周与8～11周成功率第1组分别为19％和25％,第2组分别为37％和30％。③4种不同阴道用药方法终止≤10周妊娠:200 μg/8     

药物终止16～24周妊娠的临床研究

目的;比较米非司酮合并米索前列醇与利凡诺羊膜腔内注射终止16～24周妊娠的临床效果及各自的优缺点。方法:将来自上海市13所医院的829例孕16～24周要求终止妊娠的妇女,随机分成2种不同的治疗组。组Ⅰ(双米组):415例,米非司酮 100mg/qd连服两天(总量 200mg),第 3天晨阴道内放置米索前列醇 0.4mg,每 12小时重复 一次,最多3次;组Ⅱ(利凡诺组):414例,羊膜腔内注射利凡诺100mg,不加任何辅助方法,胎儿胎盘娩出后常规清宫。结果:两组流产成功率分别为91.6％和92.3％,两组间的差异有显著性意义(P>0.05);两组流产成功者用药至胎儿排出时间分别为57.69±7.85小时和46.92±10.06小时,两组间的差异有显著性意义(P<0.01);两组流产成功者产程分别为8.09±6.97小时和11.4±8.28小时,双米组产程时间明显短于利凡诺组,P>0.001;流产后阴道流血量和阴道流血时间两组间差异无显著性意义(P>0.05);双米组胃肠道反应和头痛、眩晕等副反应发生率高于利凡诺组(P<0.05),但无需处理。结论:口服米非司酮200mg合并阴道放置米索前列醇是较好的药物终止16～24周妊娠的方法,可以作为一种常规方法在有条件的医院中应用。     

Induction of second trimester abortion (12-20 weeks) with mifepristone and misoprostol: a review of 386 consecutive cases

DESIGN: A retrospective analysis of 386 women who underwent termination of pregnancy between 12 and 24 weeks' gestation. METHODS: Each woman received 200 mg mifepristone orally followed by vaginal misoprostol 800 microg 36 to 48 h later. Three hours after the initial misoprostol administration, 400-microg doses of vaginal misoprostol were administered every 3 h, to a maximum of four doses in 24 h. If abortion failed, 200 mg mifepristone is given again 3 h after the last misoprostol dose, followed by 12 h of rest before vaginal misoprostol administration is repeated as per previous course of treatment. RESULTS: Overall, 97.9% and 99.5% of the women aborted within 24 and 36 h, respectively. The median induction-to-abortion interval was 6.7 h (range: 1.4-73.8 h), and nulliparous women took significantly longer time to abort (6.0 h in multiparous women compared to 7.6 h in nulliparous women; p<.0001). One woman failed to abort within 48 h. Surgical evacuation of the uterus was performed in 5% of women for incomplete abortion or retained placenta. Multiparous women were less likely to need analgesic administration for pain relief, and to experience vomiting and diarrhea, than nulliparous women. CONCLUSION: The combination of 200 mg mifepristone and vaginally administered misoprostol is a safe, effective and noninvasive regimen for termination of pregnancy between 12 and 20 weeks.     

米非司酮配伍米索前列醇终止妊娠10~14周86例临床观察

目的:探讨米非司酮配伍米索前列醇终止妊娠的临床应用效果,减少流产并发症。方法:将138例自愿要求终止10~14周妊娠的健康妇女分为两组,钳刮组52例,术前前1天宫颈管内插入导尿管,次日行钳刮人流术;药流组86例,口服米非司酮50mg共4次,第3天口服(或阴道放药)米索前列醇0·6mg。比较两种方法的效果。结果:药流组在流产中及流产后阴道流血及持续时间、子宫体压痛、感染均少于钳刮组(P<0·05),而子宫复旧、月经复潮及月经规则要早于钳刮组。结论:分次口服米非司酮配伍米索前列醇是目前最佳的终止10~14周妊娠的流产方式。     

Mifepristone and vaginal misoprostol on the same day for abortion from 50 to 63 days' gestation

In a previous study of 40 women up to 49 days' gestation, our research center demonstrated that mifepristone 200 mg followed on the same day by misoprostol 800 microg vaginally produced abortion at rates similar to standard regimens which administer the two drugs 24 or 48 h apart. We performed this study to evaluate the same regimen in women with pregnancies at 50 to 63 days' gestation. Forty women from 50 to 56 days' gestation (Group 1) and 40 women from 57 to 63 days' gestation (Group 2) inserted misoprostol vaginally 6 to 8 h after taking mifepristone. Participants were instructed to return 24 +/- 1 h after using misoprostol for an evaluation that included transvaginal ultrasonography. Subjects who had not aborted received a second dose of misoprostol to administer 48 h after the mifepristone. All participants were to return 2 weeks later. Ultrasound examinations were performed in those who required a second dose of misoprostol to confirm the abortion was successful. At 24 h after receiving misoprostol, 37/40 (93%, 95% CI 80, 98%) and 36/40 (90%, 95% CI 76, 97%) women from Groups 1 and 2, respectively, had expelled the pregnancy. By follow-up 2 weeks after taking mifepristone, all 40 women in Group 1 (100%, 95% CI 91,100%) and 39/40 women in Group 2 (98%, 95% CI 87,100%) had complete abortions. One woman in the latter group who aborted within the first 24 h had an incomplete abortion treated by suction curettage. This pilot study suggests that mifepristone 200 mg, followed on the same day by misoprostol 800 microg vaginally, effects abortion in women 50 to 63 days' gestation at rates comparable to regimens using longer dosing intervals between medications. Though this regimen is promising, larger randomized trials comparing it to standard regimens are needed before widespread use.     

Second-trimester pregnancy termination with 600-microg vs. 400-microg vaginal misoprostol and systematic curettage postexpulsion: a randomized trial

BACKGROUND: This study was conducted to compare efficacy and safety of 600 mcg of misoprostol vaginally every 6 h up to four doses vs. 400 mcg of misoprostol vaginally every 4 h up to five doses, followed by systematic curettage of the uterine cavity, for pregnancy termination between 12 and 20 weeks' gestation. STUDY DESIGN: We used a randomized clinical trial conducted at Hospital Gineco-Obstétrico "Eusebio Hernández", Havana, Cuba. Subjects were women requesting voluntary termination of pregnancies between 12 and 20 weeks' gestation. Two hundred ten women were randomly assigned to receive 600 mcg of vaginal misoprostol every 6 h up to four doses (Group I) vs. 400 mcg of vaginal misoprostol every 4 h up to five doses (Group II), followed by curettage 1 h after expulsion. The main outcomes measured were successful abortion rate and mean expulsion time. RESULTS: Successful abortion occurred in 103/105 women (98.1%) in Group I and in 99/105 (94.3%) in Group II [p=.279, relative risk (RR)=3.121 and 95% confidence interval for RR=0.615 to 15.833]. Fetus mean expulsion time was 10.7+/-1.3 (SD) h in Group I and 11.5+/-5.0 (SD) h in Group II (p=.209). CONCLUSIONS: Six hundred micrograms of misoprostol administered vaginally every 6 h was as effective as 400 mcg of misoprostol every 4 h for second-trimester pregnancy termination.     

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。     

米索前列醇在剖宫产术后早孕药物流产术中的应用

目的:探讨米索前列醇加量分次给药对剖宫产术后早孕药物流产效果的影响。方法:对100例有剖宫产史,停经≤7周的早孕患者随机分组,实验组50例,对照组50例。对照组:米非司酮25 mg,2次/d,连服3 d,于第4 d服用米索前列醇600μg;实验组:在上述方法的基础上,2 h后再加服米索前列醇400μg。结果:实验组和对照组完全流产率分别为90.00%和44.90%,不完全流产率为8.00%和48.98%,失败率为2.00%和6.12%,差异具有显著性(P<0.001),两组的出血时间分别为10.60±3.36 h和18.05±5.64 h,差异具有显著性(P<0.001),失血量实验组比对照组明显减少,两组副反应无显著性差异(P<0.107)。结论:在常规应用米非司酮配伍米索前列醇的基础上,2 h后再加服400μg的米索前列醇可提高剖宫产术后早孕药物流产术的完全流产率,缩短出血时间,减少出血量,而不增加副反应,值得临床推广应用。     

Mifepristone followed on the same day by vaginal misoprostol for early abortion.

We performed a pilot study to examine the clinical efficacy of mifepristone 200 mg followed on the same day by misoprostol 800 microg vaginally in women with pregnancies up to 49 days gestation. Forty women received mifepristone 200 mg after which they self-inserted misoprostol intravaginally 6 to 8 h later at home. Participants returned for an evaluation, including transvaginal ultrasonography, 24 +/- 1 h after using the misoprostol. Participants who had not aborted received a second dose of misoprostol to administer 48 h after the mifepristone. All participants returned approximately 2 weeks after receiving mifepristone. At 24 h after receiving misoprostol, 37/40 (92%, 95% CI 81-98%) had ultrasonographic evidence of complete abortion. By follow-up 2 weeks after the mifepristone, 40/40 (100%, 95% CI 92-100%) women were felt to have complete abortions. One subject subsequently had a suction aspiration for an incomplete abortion on study Day 44. Nausea, vomiting, diarrhea, and warmth/chills occurred in 38%, 13%, 13%, and 60%, respectively. This pilot study suggests that mifepristone 200 mg, followed on the same day by misoprostol 800 microg vaginally, effects abortion at rates comparable to regimens using the standard time interval of 48 h between medications.     

米非司酮配伍米索前列醇不同给药方法终止16～24周妊娠的有效性和安全性研究

目的：探讨米非司酮联合米索前列醇口服给药与经阴道给药终止16 ～24周妊娠的有效性和安全性.方法：85例孕16 ～24周且要求终止妊娠的妇女,按随机数字表法分为口服给药组42例,阴道给药组43例.口服给药组口服米非司酮100mg/d,连服2d,第3天晨起口服米索前列醇400μg,如未分娩,每3h重复给药400μg,不超过4次;阴道给药组米非司酮用法同前组,第3天晨起阴道内放置米索前列醇600μg,如未分娩,每12h重复给药400μg,不超过4次.比较两组引产与清宫情况,引产时间、产后出血与米索前列醇用量等.结果：口服给药组完全流产24例,不全流产16例,无效2例,总有效率为95.2％,清宫率为42.9％;阴道给药组完全流产33例,不全流产10例,无效0例,总有效率为100％,清宫率为23.3％;两组有效率比较差异无有统计学意义（P＞0.05）,清宫率比较差异具有统计学意义（P＜0.05）.口服给药组引产时间、产后24h出血量、阴道流血天数及米索前列醇用量分别为11.9±4.7h,91.3±32.6ml,21.8±15.8d和1 093.6±381.4μg;阴道给药组则分别为8.6±3.8 h,62.4±26.5 ml,20.6±13.4d和751.2±213.7μg,两组比较除阴道流血天数外,其他各项指标差异均有统计学意义（P＜0.05）.两组不良反应情况无明显差异.结论：米非司酮联合米索前列醇口服给药与经阴道给药均能有效终止16 ～24周妊娠,但经阴道给药引产时间更短,产后出血少,米索前列醇用量更小.