米非司酮配伍米索前列醇治疗稽留流产90例疗效观察

目的探索米非司酮配伍米索前列醇治疗稽留流产的疗效。方法2010年1月至2010年6月在同济大学附属第十人民医院治疗的稽留流产患者90例,停经8～14周,随机分成观察组50例与对照组40例,观察组予米非司酮200 mg第1日早晨顿服,24 h后米索前列醇600μg置于阴道后穹窿,若胚胎组织未排出,每3 h可重复阴塞1次,最多不超过4次。对照组口服己烯雌酚5 mg,每日3次,连服3 d,第4天静脉滴注缩宫素（5%葡萄糖液500 ml＋缩宫素5～10 IU）下行刮宫术。胎儿排出后24 h内行B超检查,了解流产情况,观察服药效果。结果观察组完全流产41例,占82.0%,不完全流产7例,占14.0%,无效2例,占4.0%,成功率为96%.对照组完全流产13例,占32.50%,不全流产8例,占20.0%,无效19例,占47.5%,成功率52.5%。观察组流产成功率显著高于对照组（P〈0.05）。结论米非司酮配伍米索前列醇用于治疗稽留流产完全流产率高,清宫率低,出血少,清宫容易,无需二次清宫,清宫术中人流综合征发生率低,不良反应少,显著优于传统方法（口服乙稀雌酚数天后行刮宫术）,是一种安全、可靠、方便的方法,值得临床推广应用。

Mifepristone combined with misoprostol in treatment of 90 cases of missed abortion

Objective To evaluate the efficacy of mifepristone combined with misoprostol in treatment of missed abortion.Methods Ninety missed abortion cases with 8～14 weeks of menelipsis were admitted from January 2010 to June 2010 in Tenth People’s Hospital,Tongji University.The patients were randomly divided into trial group(n=50) and control group(n=40).Patients in trial group were treated by sequential therapy:200 mg mifeprisone taken orally at the morning of the first day and then 600μg misoprostol administrated vaginally after 24 h.Misoprostol would be used again at the interval of 3 h until embryo discharged(at most 4 times).Patients in control group were given oral administration of diethylstibestrol,3 times per day for 3 days;intravenous drip of oxytocin was given on the 4 th day during uterine curettage.The efficacy was evaluated by B type ultrasonic examination 24 h after embryo discharged.Results In trial group,41 cases(82.0%) were identified as complete abortion,7 cases(14.0%) as incomplete abortion,and 2 cases(4.0%) needed further operations with a successful rate of 96%.In control group,13 cases(32.5%) were identified as complete abortion,8 cases(20.0%) as incomplete abortion and 19 cases(47.5%) needed further operations with an overall successful rate of 52.5%.The rate of complete abortion was significantly higher in trial group than that in control group(P<0.05).Conclusion The application of mifepristone combined with misoprostol in treatment of missed abortion has advantages of higher successful rate,lower operation rate,fewer blood loss and complications.