米非司酮配伍依沙吖啶及单纯依沙吖啶终止中期妊娠效果比较.docVIP

米非司酮配伍依沙吖啶及单纯依沙吖啶终止中期妊娠效果比较[摘要] 目的：探讨米非司酮配伍依沙吖啶与单纯依沙吖啶终止中期妊娠的临床效果。方法：总结本院2008年10月～2010年5月收治的65例妊娠16～24周患者的资料，将其随机分为观察组和对照组，观察组40例，口服米非司酮片50 mg，q12 h×2 d，第3天行依沙吖啶引产，对照组25例直接行依沙吖啶引产。结果：观察组平均引流产时间为（37.3±13.2） h，与对照组的（46.2±16.8） h比较，差异有统计学意义（P＜0.05），产后刮出物量也低于对照组（P＜0.05）。结论：米非司酮配伍依沙吖啶终止中期妊娠临床效果好，适宜临床广泛推广 [关键词] 米非司酮；依沙吖啶；中期妊娠；引产 [中图分类号] R979.2+2 [文献标识码] B [文章编号] 1674-4721（2011）11（c）-068-02 Comparison of mifepristone combined with ethacridine in induction of labor for the termination of second trimester pregnancy LIU Shuqin1, CHEN Yuqin2 1.The People’s Hospital of Lushan County, Henan Province, Lushan 467300, China; 2.Lushan Family Planning Service Station of Henan Province, Lushan 467300, China [Abstract] Objective: To investigate the clinical efficacy of mifepristone combined with ethacridine in induction of labor for the termination of second trimester pregnancy. Methods: The 65 women at 16-24 weeks’ gestation requesting termination of second-trimester pregnancy were randomized into observation group and control group, who were treated by the hospital from October 2008 to May 2010. The 40 women of the observation group were taken 50 mg mifepristone every 12 hours for two days and followed by the induced labor with ethacridine in the third day, while the 25 women of the control group were directly treated induced labor with ethacridine. Results: The time of induced labor in observation group was (37.3±13.2) h, which was significantly shorter than that (46.2±16.8) h in the control group (P 过去认为宫颈在分娩过程中处于被动地位，即子宫收缩使宫颈被动地扩大、回缩。然而免疫组化研究表明，宫颈在妊娠期并非静止，而是在多种因子调节下进行周期变化，包括宫颈变短、消失、软化[4]。米非司酮可引起与自然分娩过程相似的宫颈成熟过程，促宫颈成熟的作用机制在于宫颈的结缔组织成分变化，即胶原纤维发生降解和糖蛋白的成分和数量的变化，子宫肌细胞间隙连接数量增加和子宫肌层电阻下降的受体后效应，提高对缩宫素的敏感性，促进子宫肌层收缩从而提高引产的有效性[5-6]。同时米非司酮与孕激素受体的亲和力是孕激素的2～5倍，拮抗孕激素的生物效应，影响子宫螺旋动脉的胎盘血供，导致蜕膜组织出现变性、水肿、出血、坏死等病理变化。滋养细胞凋亡，蜕膜与绒毛膜板分离后容易剥离胎盘胎膜。子宫内膜的蜕膜化不能完成，致使妊娠难以维持，并且减少胎儿娩出后的组织残留量[7-8]。由于米非司酮有促宫颈成熟作用，故二者联用使引产机制得到相互补充和完善，很好地解决了中期妊娠宫颈不成熟、引产不易诱导以及产程时间长、软产道易裂伤等一系列问题，缩短依沙吖啶引产时间，减轻