小剂量米索前列醇用于足月妊娠引产

目的 :探讨小剂量米索前列醇阴道内放入用于足月妊娠引产的有效性和安全性。方法 :60例有引产指征足月妊娠孕妇分为两组。A组 3 0例 2 5 μg米索前列醇阴道内放入 ,每 2h一次 ,至胎监出现宫缩每 2 0min三次视为有效 ,最多放置 8次 ;B组 3 0例做为对照组 ,静点催产素引产。结果 :两种引产成功率分别为 86 67%和80 % (P >0 0 5 )。A组从开始用药至临产的平均时间较B组明显缩短 (P <0 0 5 ) ,宫颈评分≤ 5分的产妇引产成功率 80 % ,高于B组 5 0 % (P <0 0 5 )。两组剖宫产率、产后出血量、胎儿窘迫发生率差异均无显著性。结论 :小剂量米索前列醇阴道放入用于足月妊娠引产安全有效 ,方便 ,且效果优于催产素     

Antiinflammatory Drug-Induced Small Intestinal Permeability: The Rat Is a Suitable Model

Excretion of orally administrated ⁵¹Cr-EDTA as a marker of small intestinal permeability (a proposed prerequisite for human enteropathy) is increased by corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs). We have investigated the suitability of the rat as an animal model of small intestinal permeability using orally administered ⁵¹Cr-EDTA. We dosed Sprague-Dawley rats with NSAIDs and corticosterone followed by ⁵¹Cr-EDTA under conditions reported for humans and measured urinary excretion of the marker. In control rats, the urinary excretion of ⁵¹Cr-EDTA exhibited a skewed-to-the-left frequency distribution curve with a median of 2.13% of the dose. No sex-related differences were noticed in the baseline permeability. In male rats, single therapeutically equivalent doses of indomethacin, flurbiprofen, ibuprofen, naproxen, diclofenac, sulindac, nambumetone, and corticosterone, increased the intestinal permeability by different extents with indomethacin eliciting the maximum effect, and the last four drugs showing minimal potencies. Therapeutically relevant doses of aspirin did not have any significant effect. The increase in permeability was dependent upon the NSAIDs dose. Administration of glucose/citrate, misoprostol and sulfasalazine significantly reduced the effect of indomethacin. Misoprostol antagonized the effect of naproxen but H₂-antagonists and sucralfate did not. All the above observations made in the rat were similar to those previously reported for humans. Thus the rat is a suitable model for studies of small intestinal permeability.     

Alterations of colonic motility after oral administration of prostaglandin E1 analogue misoprostol in man

This study describes the motor changes observed in human colon under normal feeding schedule, after administration of a single oral does of misoprostol, a PGE₁ synthetic analogue. Fourteen patients (3 men, 11 women, mean age 45±7 years), with chronic abdominal pain but without any detectable organic digestive disease were studied. The colonic motor activity was recorded by endoluminal electromyography during 218-h recording sessions over 2 consecutive days. Misoprostol 600 μg or placebo was randomly administered in double-blind manner either on the first or the second day of the recording period. In 8 patients, misoprostol was administered orally 1 h before the dinner (17.30 hours) and in 6 patients at the beginning of the night-time (23.00hours). Meals were standardized and scheduled during the whole recording session in the same way for all patients. After placebo, colonic response to feeding was characterized by an increase in colonic motor activity mainly concerning the percentage of time occupied by long spike bursts (LSBs =+232%) and migrating long spike bursts (MLSBs =+214%) (p < 0.05). Short spike burst activity (SSBs) was not affected by feeding. Administered before the meal, misoprostol (600 μg) strongly reduced percentage of time occupied by the LSBs activity during post-cibal period (-46%) when compared to placebo (P < 0.01). On the contrary, MLSBs and SSBs activities were similar in post-prandial period after placebo and misoprostol. Administration of misoprostol during the nighttime did not affect the basic colonie myoelectrical pattern when compared to placebo. We conclude that an oral administration of misoprostol before a meal alters the colonic response to feeding, mainly the contractile activity of LSBs.     

Methotrexate and misoprostol for abortion at 57–63 days gestation

Methotrexate and misoprostol have been shown in preliminary studies to be effective for abortion at ≤56 days gestation with minimal side effects. RU-486 is used in combination with prostaglandin for abortion ≤49 days gestation in France but ≤63 days gestation in England. This pilot study was performed to evaluate if methotrexate and misoprsotol may also be effectve up to 63 days gestation. Ten pregnant women between 57–63 days gestation were treated with methotrexate 50 mg/m² intramuscularly followed 3 days later by misoprostol 800 μg vaginally. Abortion occurred in 6 women; abortion occurred in one of the women after a repeat dose of misoprostol 24 hours after the first dose. The remaining 4 women all had a surgical abortion. In the successfully treated women, vaginal bleeding lasted 14 ± 4 (mean ± standard deviation) days and serum β-hCG was ≤25 IU/L by 32 ± 5 days after the methotrexate injection. No methotrexate side effects occurred. Methotrexate and misoprostol do not appear to be as effective for medical abortion between 57 and 63 days gestation as compared to ≤56 days gestation.     

小剂量米索前列醇应用于足月妊娠引产50例临床分析

目的 探讨小剂量米索前列醇在足月妊娠引产中的有效性和安全性. 方法 选择有引产指征的单胎足月妊娠初产妇100例,随机分为2组:米索前列醇组50例,予25μg米索前列醇置于阴道后穹窿,6h无临产可重复同剂量用药,24 h内总量不超过50 μg;缩宫素组50例,予常规5 U/L缩宫素静滴. 结果 米索前列醇组引产有效率高于缩宫素组(96％ vs.76％,P＜0.01),且最后一次用药至临产时间为(5.48±2.44)h、分娩总产程时间为(5.59±2.56)h,分别短于缩宫素组的(8.26±6.75)h和(8.65 ±7.34)h(P ＜0.05),剖宫产率低于缩宫素组(4％ vs.36％,P＜0.01),急产率高于缩宫素组(22％ vs.2％,P＜0.01);而产后出血率、新生儿窒息率两组比较均无统计学差异(P＞0.05).结论 小剂量米索前列醇用于足月妊娠引产安全、经济、有效、方便,更值得在基层医院临床推广.     

Effect of misoprostol on histamine-stimulated acid secretion and cyclic AMP formation in isolated canine parietal cells

Isolated canine parietal cells were used to study the ability of misoprostol to inhibit acid secretion in the presence of a number of acid secretagogues. Misoprostol inhibited histamine-stimulated acid secretion in a dose-dependent and noncompetitive manner. A concentration of 2–3×10^–9 M misoprostol inhibited maximal histamine-stimulated acid secretion by one half. Misoprostol had little to no effect on acid secretion stimulated by carbachol and dibutyryl cAMP, had no effect on the acid secretion directly stimulated by pentagastrin, and only modestly inhibited acid secretion stimulated by forskolin. Misoprostol noncompetitively inhibited cAMP formation in response to histamine, with an IC₅₀ value similar to that for the inhibition of histamine-stimulated acid secretion. These results indicate that: (1) misoprostol specifically inhibits histamine-stimulated acid secretion in parietal cells, and (2) the antisecretory action of misoprostol is closely related to the reduction of histamine-stimulated cAMP formation with the site of major action most likely in the coupling process between histamine H₂ receptor sites and histamine-sensitive adenylate cyclase.     

钙剂联合米索前列醇、缩宫素防治剖宫产出血的临床观察

目的：探讨钙剂联合米索前列醇、缩宫素对剖宫产术中、术后出血的预防及治疗作用.方法：将有高危出血因素的剖宫产产妇60例分为观察组与对照组,每组30例,观察组术前应用葡萄糖酸钙,切开皮肤前肛塞米索前列醇0.2 mg,术中取出胎儿后宫体肌注缩宫素,再静脉给予缩宫素滴注,术毕直肠置米索前列醇0.2 mg;对照组单用缩宫素.观察对比两组产妇的术中出血量及产后2h,24 h的出血量.结果：观察组术中、术后2h及24 h出血量均低于对照组,差异有统计学意义（P＜0.05）.结论：剖宫产术前联合应用葡萄糖酸钙与米索前列醇,术中应用缩宫素,能有效减少术中、术后出血.     

彩超引导下经皮肝胆管穿刺术治疗阻塞性黄疸的应用及护理

目的研究彩超引导下经皮肝胆管穿刺术（PTCD）的临床应用及护理。方法26例阻塞性黄疸的患者,其中24例为恶性阻塞性病变、2例为良性阻塞性病变,在超声引导下行PTCD术;穿刺右叶胆管20例,左叶胆管4例,双叶胆管2例。结果穿刺成功率100％,在术前、术中及术后进行细致的护理,无一例出现出血及胆汁性腹膜炎等并发症。结论超声引导下PTCD是一种治疗阻塞性黄疸的有效方法,具有安全、简便、经济、并发症少的优点,在术前、术中,术后恰当的护理,可有效减少并发症的发生。     

笑气联合米索前列醇用于人工流产术的镇痛效果

目的观察笑气联合米索前列醇用于早孕人工流产术镇痛的效果。方法将200例早孕行人工流产的妇女随机分为联合组及对照组,各100例。联合组术前2 h口服米索前列醇后吸入笑气镇痛麻醉;对照组不使用任何药物。观察两组病人扩张宫颈及吸刮宫腔时的疼痛情况、宫颈扩张情况、出血量。结果联合组扩张宫颈及吸刮宫腔时疼痛程度轻于对照组,差异有显著性(uc=11.665、12.318,P<0.01);联合组6号吸管通过率高于对照组,出血量少于对照组,差异均有显著性(χ2=83.56,t=10.85,P<0.01)。结论笑气联合米索前列醇用于早孕人工流产术镇痛效果确切,能有效减轻病人痛苦,是一种较理想的镇痛方法。