三种宫内节育器(VCu200,金单和TCu200C)放置五年月经血量和血红蛋白浓度变化

本文对三种宫内节育器(IUD)VCu200 241例,金单244例和TCu220C 272例共计放置757例,观察五年。测定其月经血量和血红蛋白浓度。至五年时尚存390例。放器前平均MBL45.2ml。放器后两年内MBL 变化与文献报道相似。至五年时其MBL接近放器前平均水平。三种IUD 放器前其MBL≥80ml 而在放置五年时MBL<80ml者占19.77%。放器前MBL<80ml 在放器后第1年MBL≥80ml,至五年时其MBL<80ml 者占44.35%。放器后Hb 浓度金单组普遍低于放器前Hb 平均水平,VCu200与TCu220C 组的Hb 浓度反较放器前高。     

三种宫内节育器（VCu200，金单和TCu200C）放置五年月经血量和血红蛋白浓度变

本文对三种宫内节育器（IUD）VCu200 241例，金单244例和TCu220C 272例共计放置757例，观察五年。测定其月经血量和血红蛋白浓度。至五年时尚存390例。放器前平均MBL45．2ml。放器后两年内MBL变化与文献报道相似。至五年时期MBL接近放器前平均水平。三种IUD放器前其MBL≥80ml而在放置五年时MBL＜80ml者占19．77％。放器前MBL＜80ml在放器后第1年MBL≥80ml，至五年时其MBL＜80ml者占44．35％。放器后Hb浓度金单相普遍低于放器前Hb平均水平，VCu200与TCu200C组的Hb浓度较放器前高。     

放置宫内节育器妇女的血清铁蛋白测定

229名天津健康妇女血清铁蛋白(Fer)正常对照值为35.5ng/ml。60例放置宫内节育器(IUD)妇女于放器前周期为28.5ng/ml;放器后第6、12周期分别显著下降到18.8和18.6ng/ml,P<0.01,缺铁率分别增加到45.5和48.1%,第24周期Fer回升至22.3ng/ml,P>0.05,缺铁率略有减少。但月经血量(MBL)>80ml者例外,其缺铁率持续进行性增高,第24周期达66.7%。文内结合MBL和Hb值,分析放器妇女Fer改变的临床特点和意义,提出使用Fer测定可及早对缺铁状态进行防治的措施。     

我国四种宫内节育器对月经血量的影响——放器后二年的观察

本文对我国四种节育器(不锈钢单环、Tcu200、上海Vcu200及北京Vcu200)进行放置前后月经血量与血红蛋白测定的连续动态观察。四种节育器放置后月经血量均有明显增加,到一年时尚未恢复到放器前水平(P<0.05)。本文为报道第二年的实验结果,第二年时经血量与月经过多的发生率均已下降并接近放器前水平(P>0.05),但仍有6例(约11%)经血量持续在100ml 以上,Hb 在放器后有逐渐下降趋势,第二年低于12g/100ml 者比第一年有所增加。     

含消炎痛VCu200结构改进后的临床观察

用改进后的消炎痛VCu200（药V）与VCu200、TCu220进行随机比较性研究，共300例。在24个月末，每100妇女累积续用率分别为95．00％、82．66％、87．60％。妊娠：药V组无，VCu200有1例，TCu220有2例。脱落：药V组与TCu220各为2例，vCu200有4例。因症取出主要原因是月经过多及点滴出血分别为2例、7例、5例。月经过多的发生率，药V组显著低于对照组，在18个月内（P＜0.05），3个月内（P＜0．01）；点滴出血的发生率，药V组也显著低。因此，在结构与工艺上改进后的合消炎痛VCu200不但续用率有所提高，且能减少月经过多及点滴出血，有必要进一步多中心临床研究。     

放置含铜V型宫内节育器后的经血量测定

本文研究了116例放置含铜V 型宫内节育器前及放置1、2、3、6、12个月后的妇女经量和血红蛋白的变化。放器前,妇女的平均经量为45.4毫升,放器后不同时间分别为81.8、69.6、69.4、71.0、68.6毫升。经统计学处理差异非常显著(P<0.01)。血红蛋白在放器前后无显著差异(P>0.05)。文内对放置含铜V 型宫内节育器后经量增多的可能因素及血红蛋白变化不明显的原因进行了讨论。     

含消炎痛IUD对家兔子宫内膜影响的酶组织化学观察

本文采用酶组织化学方法观察了含消炎痛IUD对家兔子宫内膜几种酶的影响,并与全铜、硅胶及铜加消炎痛IUD进行了比较.结果表明:(1)含消炎痛IUD组子宫内膜NSE、SDII和ATPase三种酶活性增强;全铜IUD组则上述三种酶活性明显下降;加消炎痛的含铜IUD组子宫内膜酶活性低于含消炎痛IUD组,但高于硅胶对照组.(2)全铜IUD组子宫内膜损伤较明显.由此可见,含消炎痛IUD对子宫内膜上皮功能及结构的损害均小于含铜IUD.     

正常妇女与放置宫内节育器妇女月经中期宫颈粘液的量、物理性质和前列腺素含量的比较

为了探讨放置宫内节育器与不放器妇女宫腔局部环境的变化,本文对35例放器10个月的妇女于月经中期(月经周期的第10～14天)测定了宫颈粘液的量、物理性质和PGE_2、PGF_(2α)的含量。结果表示,放器组妇女月经中期一次取样的宫颈粘液平均重量为275.43±167.1毫克,对照组为226.56±150.22毫克(P>0.2)。两组妇女宫颈粘液的物理性质(透明度、粘稠性、拉丝度和结晶型)没有差别。宫颈粘液中PGE_2在放器组为41.00±22.06pg/毫克,对照组为39.12±27.32pg/毫克;PGF_(2α)在放器组为66.34±42.42pg/毫克,对照组为73.15±52.56pg/毫克(P>0.5)。两组妇女月经中期一次取样宫颈粘液在量、物理性质和前列腺素E_2、F_(2α)的含量上未见显著差异。     

消炎痛Vcu200 IUD减少月经过多的机理

自１９９２年１１月至１９９５年６月，对４６例放置无消炎痛ＶＣｕ２００ＩＵＤ及２４例含消炎痛ＶＣｕ２００ＩＵＤ妇女的子宫内膜中６－ｋｅｔｏ－ＰＧＦ１α、ＴＸＢ２及纤溶指标包括ｔ－ＰＡ、ＰＡＩ、ＰＫ、ＰＬＧ、Ｄ－Ｄ及ＦＤＰ的水平进行测定，同时作光、电镜观察置器后ＩＵＤ对子宫内膜的影响。结果：１．无消炎痛ＶＣｕＩＵＤ３月组置器后６－ｋｅｔｏ－ＰＧＦ１α／ＴＸＢ２比值明显高于置器前（Ｐ＜０．０５），ｔ－ＰＡ、ＰＫ、ＰＬＧ、Ｄ－Ｄ及ＦＤＰ均非常明显低于置器前水平（Ｐ＜０．ｏ１～０．００１）。２．无消炎痛ＶＣｕＩＵＤ＞６月组置器后只ｔ－ＰＡ、ＰＫ、ＦＤＰ明显低于置器前水平（Ｐ＜０．０１～０．００１），其余指标均无统计学差异。３．放置合消炎痛ＶＣｕＩＵＤ３个月后６－ｋｅｔｏ－ＰＧＦ１α、ＴＸＢ２及各项纤溶指标与置器前比均无统计学意义。４．子宫内膜形态学变化与置器前相比，表现为血管内血栓形成减少及末梢小血管腔扩大。根据上述结果，置器后内膜中６－ｋｅｔｏ－ＰＧＦ１α／ＴＸＢ２值升高，与ｔ－ＰＡ水平下降可能是置器后月经过多的主要原因，尤以前者起主导作用。本文并对消炎痛ＩＵＤ减少月经过多的作用机理进行了讨论。     

镍钛记忆合金夹输卵管绝育后卵巢功能的探讨

用镍钛记忆合金夹输卵管绝育后91例月经正常的妇女于黄体中期进行血孕酮(P)及雌二醇(E_2)测定,与正常对照组及输卵管结扎组比较。合金夹组平均血孕酮(12.76±5.76ng/ml)与正常对照组(11.82±3.82ng/ml)无显著差别(P>0.05),而结扎组孕酮(8.20±3.13ng/ml)明显低于前两组(P<0.01)。合金夹组中孕酮值<10ng/ml之发生率(31例占37.08%)与正常对照组者(6例占30%)无显著差别(P>0.05),而结扎组者(12例占75%)明显高于前两组。三组中雌二醇均值无显著差别(P>O.05)。说明避开输卵管系膜内血管放置合金夹,较少影响卵巢的血液供应及神经内分泌功能,故对卵巢功能影响不明显。     

18甲基炔诺酮阴道环的临床观察

本文介绍108例妇女使用释放左旋18甲基炔诺酮20微克/天阴道环一年的临床效果和副反应。每100例妇女使用一年的净累积率为:妊娠率3.7,脱落率4.6,与阴道环有关的停用率26.9,持续使用率71.2。副反应主要为月经紊乱,但随使用时间的延长而逐步改善。本文有20例首进行月经血量,血红蛋白和铁蛋白测定。使用阴道环后第一月,经血量略有增加,此后有下降趋势,血红蛋白浓度在放环后第6和第12月有明显增加(P<0.05)。     

含孕酮宫内节育器减少经血量机制的初步探讨——放置宫内节育器前后月经血及外周血纤溶活性、抗凝血酶Ⅲ和因子Ⅷ相关抗原的变化

本文观察了22例放置孕酮宫内节育器和19例放置不含孕酮的宫内节育器妇女上环前及上环后月经第一天之月经血及周围静脉血中纤溶活性、抗凝血酶Ⅲ(AT-Ⅲ)和因子Ⅷ相关抗原(ⅧR:Ag)的变化。以探讨放置孕酮宫内节育器后经血量减少的机制。结果表明:放置孕酮IUD妇女经血量减少的机制既不是AT-Ⅲ活力的变化,亦不是通过合成、释放ⅧR∶Ag的增加从而加强血小板的粘附作用。而经血中纤溶活性的降低则可能是置孕酮IUD者经血量减少的重要机制之一。     

三种国产宫内节育器随机化多中心比较性研究(二年随访总结)

全围13省、市共23个单位,对不锈钢金属单环,V铜200及T铜220C进行随机化临床多中心比较性研究。自1983年7月1日至1984年3月31日共接受对象6,236例,其中210例作放置前后的月经血量和相应的血红蛋白测定。全组二年中仅有45例失访,随访率达99.28%。而二年末的每百妇女累积续用率分别为68.08%、85.99%及87.59%。结果表明:金单的脱落率和妊娠率显著地高于V铜及T铜(P<0.001);但因医疗原因取出率则以金单显著低于V铜及T铜(P<0.05～0.01)。副反应的发生率,三种宫内节育器均以放置后第一个月为最多,金单较二种带铜节育器显著为少(P<0.001),而V铜与T铜则甚为相近。它们均能引起月经血量的增加和血红蛋白的降低,以第3月经周期最为明显。到第24月经周期时仍未完全恢复到原有水平,但与第3周期相比,已有显著改善。     

The effects of four types of IUD in China on menstrual blood volume]

54 IUD users participated in a study of the influence on menstrual blood level (MBL) and hemoglobin (Hb) level of 4 IUD types: the stainless steel ring, Tcu200, Shanghai Vcu200, and Beijing Vcu200. Among those participants, 17 used the stainless steel ring; 16, the Tcu200; 14, the Shanghai Vcu200; and 7, the Beijing Vcu200. Based on observations made during the first 12 cycles after insertion of the IUD, a continuous monitoring of the MBL and Hb was performed between the 24th and 26th cycles of the 2nd year. The preinsertion mean MBL was 53.3 ml, and it showed a significant increase after the insertion. The mean MBL had decreased to an average of 71.4 ml by the 12th cycle, and decreased even further to an average of 59.2 ml between the 24th and 26th cycles. Based on the standard of 80 ml, which constitutes menorrhagia, the preinsertion mean incidence of menorrhagia of the 4 IUD types was 16.7%. It was 27.8% by the 12th cycle, and 22.2% between the 24th and 26th cycles. The mean Hb volume in 46 of the 54 subjects before insertion was 12.1 g/dl. This decreased to 11.7 g/dl between the 24th and 26th cycles. The results of the study indicate that, although the insertion of an IUD causes a temporary increase in MBL and menorrhagia, the 2 return to their preinsertion level about 2 years after the initial insertion.     

Clinical investigation of a low-dose levonorgestrel-releasing vaginal ring

Contraceptive effectiveness and adverse effects were observed in 108 women who used the levonorgestrel-releasing vaginal ring. One-year cumulative net rates per 100 women were pregnancy, 3.7; expulsion, 4.6; use-related discontinuation, 26.9; and continuation, 71.2. The main adverse effects were menstrual disturbances, which improved after longer usage. The menstrual blood loss (MBL), hemoglobin (Hb), and ferritin concentrations were determined in 20 women. The MBL gradually declined after insertion of the vaginal ring and the Hb concentration was significantly increased in the 6th and 12th periods after insertion (P less than 0.05).     

Modification of the cervical flora by IUCD

The study objective was to examine the cervical flora during the insertion of an IUD and to determine whether the presence of the device in utero modified this flora. A secondary objective was to determine whether the colonization of the cervix with (occasionally) pathogenic bacteria warrants a prophylactic antibiotic treatment. IUDs were inserted in a group of 20 women, ranging in age from 23-40 years, at the Family Planning Clinic of Meir Hospital in Kfar Saba, Israel. The cervical bacterial flora was examined during insertion and again after a period of 3-12 months with the IUD in situ. None of the women received antibiotic or antifungal treatment for 3 months prior to or 12 months after insertion. The women were divided into 2 groups according to the type of IUD used. Group A consisted of 22 women with nonmedicated IUDs and Group B included 28 women with IUDs medicated with copper. A cervical swab was collected during insertion of the IUD and at 3-12 months afterwards. Of the 50 cervical cultures collected during the insertion, 48 (84%) were sterile, but only 27 of the cultures collected after 3-12 months with the IUD in utero were sterile. The medicated IUD had a more intense bacteriostatic effect on the bacterial cervical flora than the other devices. Among the copper IUDs the best results were obtained with the Nova T type and secondly with the Copper 7 (Gravigard). It is possible that the pathogenic organisms enter the uterine cavity and tubes from the cervix during insertion of the IUD. It may be concluded that during IUD insertion prophylactic treatment with a broad spectrum antibiotic would be indicated, but the study showed that this was not the case. The organisms isolated in the women studied were those normally found in the upper vagina and cervix and only occasionally became pathogenic. Medicated IUDs are preferable because of the bacteriostatic activity of the copper and to the fact that they are normally left in utero for a shorter time than the unmedicated IUDs.     

Comparative study of norplant-2 and levonorgestrel-releasing intrauterine devices

Norplant-2 and Levonorgestrel-releasing IUD were studied in a randomized comparative trial for one year. Each group consisted of 100 healthy women among whom contraceptive efficacy and acceptability were studied. Only one woman with the LNG-IUD got pregnancy during the 12 months of use. Expulsion rate was 3.0 in the LNG-IUD. Removal rate for menstrual problems was 3.0 for both groups. The use-related discontinuation were 4.0 and 10.0 respectively. Irregular bleeding was the major side-effect with the two devices. Menstrual blood loss (MBL) and haemoglobin concentration were measured in thirty women at pre- and post-insertion periods. After the 1st, 6th, 12th month of use in Norplant-2 group, the mean MBL were all less than that of pre-insertion, but the differences were not significant. Among LNG-IUD users, the MBL decreased significantly after one year of use. Haemogloblin concentrations were slightly increased in both groups.     

三种宫内节育器对月经失血量和血铁影响的比较研究

本文用随机的方法对60名健康妇女放置不锈钢单环、Vcu 200和Tcu 220c 3种节育器,并在放器前、后进行月经血量、血红蛋白浓度和血清铁蛋白测定。结果表明,不锈钢单环在放器后无论月经血量、月经过多和缺铁性贫血的发生率均明显比Vcu 200和Tcu 220c为低。Vcu 200和Tcu220c二者的结果则近似。     

Preventive treatment of intrauterine device-induced menstrual blood loss with tranexamic acid in Chinese women

OBJECTIVES: To investigate whether tranexamic acid (Transamin) therapy reduces the amount of menstrual blood loss (MBL) and occurrence of menorrhagia after intrauterine device (IUD) insertion. METHODS: Some 175 Chinese women attending for IUD insertion were equally assigned into 2 Transamin groups (1,000 and 500 mg, twice daily) and a placebo group. Their MBL was recorded with a pictorial chart in 3 subsequent menstrual cycles after insertion, while the MBL of 64 patients, collecting used sanitary towels, was also measured by an alkaline hematin method. RESULTS: A significant decline in post-insertion MBL and occurrence of menorrhagia was found in the 2 Transamin groups compared with the placebo group (p<0.05), whereas the difference in the results from the pictorial chart score was not statistically significant between the 1 g group and placebo group. CONCLUSION: Transamin treatment with a generally recommended dosage can effectively reduce the amount of IUD-induced MBL and prevent menorrhagia in Chinese women. A lower dosage than recommended (50% of recommended dosage) may have a similar preventive effect.