米索前列醇不同给药途径用于异丙酚无痛人工流产术的临床观察

目的:观察米索前列醇用于异丙酚静脉麻醉下人工流产术中,不同给药途径的临床效果,以选择最佳的无痛流产方法。方法:将120例早孕拟行异丙酚无痛人工流产术的妇女随机分为4组,每组30例。A组术前4小时口服米索前列醇400μg;B组术前2小时阴道内放置米索前列醇400μg;C组术前2小时直肠放置米索前列醇400μg;D组术前不用米索前列醇。4组受术者均以异丙酚静脉麻醉,再行负压吸宫术。观察宫颈扩张效果、手术时间、术中出血量、异丙酚用量、麻醉效果及术前的阴道出血量、腹痛、腹泻等不良反应。结果:A、B、C3组的宫颈扩张效果、手术时间、术中出血量、异丙酚用量、麻醉效果与D组相比有显著性差异(P<0.001),而A、B、C3组之间均无明显差异(P>0.05);C组的腹痛、腹泻、术前的阴道出血等不良反应显著低于A组与C组(P<0.001)。结论:直肠置米索前列醇用于异丙酚静脉麻醉下人工流产术可有效地扩张宫颈,缩短手术时间,减少术中出血量及异丙酚用量,提高麻醉效果,而且不良反应少,值得推广应用。

Different Approaches of Using Misoprostol in Indolence Artificial Abortion by Intravenous Propofol

Objective: To observe the clinical effect of different approaches of misoprostol in painless artificial abortion by intravenous propofol, and to find the best way of painless artificial abortion. Methods: 120 women with early pregnancy who asked for painless artificial abortion were randomly divided into four groups, each 30 cases. The women in group A took 400 μgmisoprostol four hours before operation. The women in group B were vaginally administered 400 μgmisoprostol two hours before operation. The women in group C were administered 400 μgmisoprostol to the rectum two hours before operation. The women in group D did not use misoprostol before operation. All women received the artificial abortion (vacuum aspiration) after intravenous propofol. The following parameters were observed: the dilatation of cervix, the operative time, amount of bleeding during operation, the dosage of propofol, the anesthetic effect and side-effect such as the vaginal bleeding before the operation, bellyache and diarrhea ect. Results: Comparing those in group D,there was significant difference in the dilatation of cervix, the operative time, amount of bleeding during operation, the dosage of propofol and the anesthetic effect in Group A ,B and C (P<0.001). There was no significant difference in group A ,B and C (P>0.05). The incidence of side-effect such as the vaginal bleeding before the operation, bellyache and diarrhea in group C was lower than those in group A and B (P<0.001). Conclusion: Administering misoprostol to the rectum combined with intravenous propofol is effective for dilating the cervix, shortening the operative time, reducing amount of bleeding during operation and the dosage of propofol, improving the anesthetic effect and reducing side effects in painless artificial abortion, so it is recommended.