米索前列醇在妊娠早期人工流产术中的应用

目的探讨米索前列醇应用于初次妊娠早期（≤42d）人工流产术前的可行性、安全性及有效性。方法2008年1月至6月，将300例18～28岁初次妊娠，妊娠时间≤42d，在本院行人工流产术患者随机分为口服米索前列醇组（A组，n=100）、阴道放置米索前列醇组（B组，n=100）和未使用米索前列醇对照组（C组，n=100）（本研究遵循的程序符合本院人体试验委员会制定的伦理学标准，并得到该委员会批准，且分组征得患者本人知情同意）。A组术前2h口服米索前列醇400μg，B组术前2h阴道放置米索前列醇400μg，C组不使用任何药物。观察并比较两组用药的不良反应发生率、宫颈扩张效果、术中出血量、手术时间及术后宫颈粘连发生情况。结果B组患者药物不良反应发生率低于A组，两组比较，差异有显著意义（P〈0．01）。A，B两组宫颈扩张效果、术中出血量、手术时间及术后宫颈粘连发生率比较，差异无显著意义（P〉0．05），但分别与C组比较，差异有显著意义（P〈0．01）。结论口服和阴道放置米索前列醇均可作为初次妊娠早期行人工流产术前的给药方法，更推荐用药后不良反应较小的阴道放置方式。

Application of Misoprostol Before Artificial Abortion for the Early Pregnancy

Objective To evaluate the feasibility, safety and efficacy of applying Misoprostol before artificial abortion for early pregnancy （442 days）. Methods From January to June, 2008, 300 early pregnant women who choose artificial abortion were randomly and evenly divided into 3 groups. Group A （n= 100） took Misoprostol 400 μg orally and group B were placed Misoprostol 400 μg transvaginally two hours before operation. Group C （control group, n=100） did not take Misoprostol. Informed consent was obtained from all participates. The incidence rate of adverse reactions and post-operative cervical adhesion, effects of cervical dilatation, bleed volume during operation, operative duration were compared between three groups. Results The incidence rate of adverse reactions of group B was significantly lower than that of group A（P〈0.01）. There were no significant differences in the effects of cervical dilatation, bleed volume in operation, operative duration, and incidence rate of operative cervical adhesion between group A and B （P〉0.05）, however, there had significant difference between group A, B and group C （P〈0.01）. Conclusion Oral misoprostol 400 μg and vaginal misoprostol 400 μg could be a route administration applying for softening the cervix and facilitating cervix dilatation in artificial abortion of early pregnancy women. We recommend vaginal misoprostol because of less incidence rate of adverse reactions.