米非司酮配伍米索前列醇加直肠放置复方萘普生栓终止早孕的临床观察

目的观察米非司酮配伍米索前列醇加直肠放置复方萘普生栓终止早孕的疗效及并发症。方法将200例早孕患者随机分为两组,每组100例。实验组患者口服米非司酮配伍米索前列醇,加直肠放置复方萘普生栓;对照组患者仅口服米非司酮配伍米索前列醇,比较两组患者的完全流产率、不全流产率、出血时间、腹痛等情况。结果实验组完全流产率高于对照组,但差异无统计学意义,而出血时间、腹痛等情况低于对照组,差异有统计学意义。结论米非司酮配伍米索前列醇加直肠放置复方萘普生栓终止早孕完全流产率高,并发症较少,安全可行。     

米索前列醇直肠给药联合缩宫素预防产后出血临床疗效观察

目的观察米索前列醇直肠给药联合缩宫素预防产后出血的临床疗效,探讨其临床应用价值。方法选取2010年1月～2011年8月于本院住院并足月妊娠且有产后出血高危因素的产妇98例,随机分为对照组与治疗组,每组各49例,对照组在胎儿娩出后第三产程早期给予缩宫素,观察组在对照组基础上给予米索前列醇直肠给药。观察并比较两组产妇产后出血量和产后出血发生率。结果观察组患者产后出血量为（170.32±13.32）mL,明显少于对照组的（289.47±14.14）mL,观察组第三产程时间为（6.11±0.54）min,明显少于对照组的（10.24±0.61）min,且两组患者产后出血发生率观察组小于对照组（分别为2.04%和12.24%）,两者比较差异均具有统计学意义（P〈0.05）。结论米索前列醇直肠给药联合缩宫素预防产后出血疗效显著,不良反应少,值得临床进一步推广和应用。     

米非司酮联合米索前列醇在子宫内膜不典型增生治疗中的疗效评价

目的探讨米非司酮与米索前列醇在治疗子宫内膜不典型增生中的疗效。方法选取无禁忌证,拒绝手术并自愿接受米非司酮治疗的子宫内膜不典型增生患者40例,随机分为治疗组和对照组,每组20例,分别采用米非司酮联合米索前列醇治疗方案和传统的甲羟孕酮单一用药方案进行治疗。结果米非司酮联合米索前列醇治疗组的疗效明显优于甲羟孕酮单一用药组,差异具有统计学意义（P〈0.05）。结论采用米非司酮联合米索前列醇治疗方案治疗子宫内膜不典型增生安全有效。     

米非司酮与米索前列醇不同配伍方式用于药物流产的临床对比观察

目的探讨米非司酮与米索前列醇不同配伍方式用于药物流产的临床效果。方法分析笔者所在医院米非司酮与米索前列醇不同配伍方式用于药物流产的临床资料,依据配伍方式不同分为治疗Ⅰ组150例和治疗Ⅱ组150例。结果两组要求终止妊娠孕妇胚囊排出时间、阴道出血时间、月经复潮时间差异均无统计学意义(P>0.05),但治疗Ⅱ组要求终止妊娠孕妇流产效果优于治疗Ⅰ组,差异均有统计学意义(P<0.05)。结论适当提高米非司酮的用量配伍米索前列醇不仅可以提高流产效果,同时不影响其他指标的恢复,值得临床推广应用。     

Prostaglandin E1 and misoprostol increase epidermal growth factor production in 3D-cultured human annulus cells

Background contextEpidermal growth factor (EGF) is a peptide known to modulate a number of cellular responses including embryogenesis, cell proliferation, and cell survival. Little is known about EGF and its regulation in human annulus cells. Previous work has identified EGF and its receptor in control outer annulus disc tissue, but not in herniated tissue.PurposeTo determine if human annulus cells express EGF in vitro, to determine if the epidermal growth factor-receptor (EGF-r) was expressed in vivo and in vitro in disc cells, to test the effect of EGF on annulus cell proliferation and proteoglycan production in vitro, and to test the effect of prostaglandin E1 (PGE1) and misoprostol on disc cell production of EGF in vitro.Study design/settingStudies were approved by the authors' Human Subjects Institutional review Board. Human disc tissue was used for immunocytochemistry, and human annulus cells were tested in vitro.Patient sampleThirty-four disc specimens were used for studies of proteoglycan production, cell proliferation, and EGF production in vitro. An additional nine discs were used for EGF-r immunolocalization.MethodsDisc tissue was used for immunocytochemical studies for the localization of EGF-r and as a source for cultured annulus cells. Monolayer culture was used to test proliferation responses to 0, 25, 50, or 75 ng/mL EGF over a 2-day culture period. Three-dimensional (3D) culture in a collagen sponge was used to test 100,000 cells cultured in a paired experimental design over 14 days for production of EGF and proteoglycans. Cells were exposed to control conditions, or to either misoprostol at 8 ng/mL or PGE1 at 10^?7 M. Conditioned media was harvested and assayed using an enzyme-linked immunosorbent assay (ELISA) assay with the Human Protein Cytokine Antibody Array I kit. Replicate EGF relative intensity values were averaged and normalized to controls assayed on the same membrane. 3D-cultured cells were also used to confirm EGF gene expression using microarray analysis. Standard statistical methods were used to analyze results.ResultsMicroarray analysis of mRNA from annulus cells in 3D culture confirmed expression of EGF, and immunocytochemistry verified the presence of EGF-r in vitro and in vivo. PGE1, at a dose of 10^?7 M, and misoprostol (a synthetic PGE1 analog) at a dose of 8 ng/mL, both significantly increased EGF levels in annulus cells cultured in 3D compared with control levels (p=.031 and .034, respectively). No significant difference, however, was seen in cell proliferation or in total sulfated proteoglycan production in EGF-exposed annulus cells.ConclusionsData showed that EGF is expressed and produced by annulus cells in vivo and in 3D culture, with significantly greater in vitro EGF produced in the presence of PGE1 or the PGE1 analog misoprostol. Misoprostol, developed for prevention/treatment of nonsteroidal anti-inflammatory-induced gastropathy, has now been reported to have some interesting anabolic effects stimulating osteoblasts during fracture healing and during ovariectomy in animal models. Exogenous EGF did not increase cell proliferation in monolayer, or total production of proteoglycans in 3D culture. Additional work is needed to further delineate the role of EGF in the human disc.     

米索前列醇阴道给药加宫颈表面麻醉用于人工流产的临床研究

目的：探讨米索前列醇阴道给药加宫颈表面麻醉用于早孕人工流产的临床效果。方法：将早孕患者随机分成观察组和对照组两组,每组100例,观察组人工流产术前2h将米索前列醇0.6mg放置阴道后穹窿,手术时行宫颈表面麻醉,对照组行传统人工流产术,比较两组流产过程中宫颈扩张难易程度,腹痛情况,阴道流血情况,手术时间,完全流产率及术后不良反应等指标。结果：与对照组相比,观察组的宫颈扩张成功率高,手术时间短,术中出血少,术中疼痛程度轻及术后出血时间短,与对照组相比有显著差异性,完全流产率达100%,未出现并发症。结论：米索前列醇术前阴道给药,加术时宫颈表面麻醉法终止早孕,可扩张宫颈,降低手术难度,手术时间短,术中疼痛程度轻,术中出血少,术后出血时间短。     

中期妊娠引产124例临床分析

目的：了解妊娠中期药物引产特点。方法：临床病例分析妊娠中期药物引产后密切随访者与无规范随访者引产效果。结果：密切随访者与无规范随访者完全流产率差异无统计学意义（P〉0.05）,有密切随访者流产后出血时间比无规范随访者明显缩短（P〈0.01）。结论：妊娠中期药物引产后应注意密切随访。     

单独应用米索前列醇紧急避孕临床效果观察

目的研究女性黄体早期单独应用米索前列醇进行紧急避孕的有效性、安全性和可接受性。方法采用前瞻性临床研究,选择符合接收标准、要求紧急避孕、并愿意参加本课题研究的221例育龄妇女作为研究对象。分米索前列醇组(78例)、米非司酮组(71例)、无避孕组(72例)三组,米索前列醇组空腹顿服米索前列醇200μg×2片,米非司酮组单次口服米非司酮25mg,预约预期下次月经后10d内随访。观察在黄体早期用药后的妊娠率、月经的变化和副作用。结果①米索前列醇组1例妊娠,失败率为1.3%,米非司酮组无妊娠,失败率为0;无避孕组12例妊娠,失败率为16.7%,米索前列醇组、米非司酮组与无避孕组间均有显著性差异。米非司酮组与米索前列醇组之间无显著性差异。②随访时米索前列醇组77例、米非司酮组71例及无避孕组60例月经已经来潮,米索前列醇组及米非司酮组开始出血时间早于无避孕组,经检验有显著性差异(p<0.05),而米索前列醇组与米非司酮组之间无差异(p>0.05);出血持续时间3组间无显著性差异,与正常月经经期基本一致。③应用两种药物均无不良后果,副作用轻,能自行缓解。结论黄体期单独应用米索前列醇紧急避孕也是有效、安全和可行的方法。     

Effectiveness of medical abortion with mifepristone and buccal misoprostol through 59 gestational days

Background

From 2001 to March 2006, Planned Parenthood Federation of America (Planned Parenthood) health centers throughout the United States provided medical abortions principally by a regimen of oral mifepristone, followed 24-48 h later by vaginal misoprostol. In late March 2006, analyses of serious uterine infections following medical abortions led Planned Parenthood to change the route of misoprostol administration and to employ additional measures to minimize subsequent serious uterine infections. In August 2006, we conducted an extensive audit of medical abortions with the new buccal misoprostol regimen so that patients could be given accurate information about the success rate of the new regimen.

Objectives

We sought to evaluate the effectiveness of the buccal medical abortion regimen and to examine correlates of its success during routine service delivery.

Methods

In 2006, audits were conducted in 10 large urban service points to estimate the success rates of the buccal regimen. Success was defined as medical abortion without vacuum aspiration. These audits also permitted estimates of success rates with oral misoprostol following mifepristone in a subset in which 98% of the subjects stemmed from two sites.

Results

The effectiveness of the buccal misoprostol-mifepristone regimen was 98.3% for women with gestational ages below 60 days. The oral misoprostol-mifepristone regimen, used by 278 women with a gestational age below 50 days, had a success rate of 96.8%.

Conclusion

In conjunction with 200 mg of mifepristone, use of 800 mcg of buccal misoprostol up to 59 days of gestation is as effective as the use of 800 mcg of vaginal misoprostol up to 63 days of gestation.