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目的系统评价阴道及舌下使用米索前列醇与安慰剂比较用于孕早期人工流产手术扩张宫颈的有效性和安全性。方法检索相关文献并进行Meta分析。据异质性检验(α=0.05)结果采用固定效应模型、敏感性分析或随机效应模型等处理,结果以比值比(OR)或加权均数差(WMD)及其95%可信区间表示。结果纳入文献5篇共482例,均为随机对照试验。其中经阴道给药4篇,舌下给药1篇。人工流产术前经阴道和舌下使用米索前列醇与安慰剂比较宫颈扩张度好的比例均较高。经阴道使用可缩短手术时间,但在其他有效性指标上无明显差异;舌下使用可减少术中出血量。胃肠道副作用发生率在两种给药途径中均无显著差异。结论米索前列醇经阴道或舌下给药在扩张宫颈方面均有较好的临床效果,经阴道使用尚可缩短手术时间。在其他有效性指标和安全性方面,尚有待更多证据加以评价。
OBJECTIVE: To evaluate the efficacy and safety of misoprostol for vaginal and sublingual use in the first trimester of abortion compared with placebo. Methods Retrieval of relevant literature and meta-analysis. According to heterogeneity test (α = 0.05), the results were treated by fixed effects model, sensitivity analysis or random effects model. The results were expressed as odds ratio (OR) or weighted mean difference (WMD) and its 95% confidence interval. Results A total of 482 articles were included in the literature, all of which were randomized controlled trials. Among them, 4 were transvaginal and 1 was sublingual. Transvaginal and sublingual misoprostol prior to abortion had a higher rate of cervical dilatation compared with placebo. Transvaginal use can shorten the operation time, but no significant difference in other effectiveness indicators; sublingual use can reduce intraoperative bleeding. There was no significant difference in the incidence of gastrointestinal side effects between the two routes of administration. Conclusions Transvaginal or sublingual administration of misoprostol has a good clinical effect in dilating cervix. Transvaginal operation can shorten the operation time. In terms of other effectiveness indicators and safety, more evidence needs to be evaluated.