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目的探讨戊酸雌二醇配伍米索前列醇在稽留流产中的应用价值。方法选择2011年7月至2012年7月北京积水潭医院门诊就诊的、孕周≤13周稽留流产患者77例,征求患者意愿分成药物流产组(A组42例)及人工流产组(B组35例),A组再随机分成A1组(22例)和A2组(20例)。所有患者均先口服戊酸雌二醇5 mg,每日3次,连服3 d。A1组患者于第4天口服米索前列醇600μg;A2组于第4天口服米非司酮150 mg,第6天口服米索前列醇600μg;B组患者35例,直接行清宫术治疗。观察A1、A2、B组3组疗效。结果 A1与A2组相比,完全流产率、米索前列醇用量、胎囊排出时间、胎囊排出后阴道出血量、月经复潮时间相比无统计学差异(P>0.05);A1组胎囊排出时出血量多于A2组,但胎囊排出后阴道出血时间明显少于A2组(P<0.05)。A1组与B组比较,A1组胎囊排出后阴道出血量稍多于B组(P<0.05),而胎囊排出或手术中出血量、术后出血时间、月经复潮时间相比差异均无统计学意义(P>0.05)。结论米非司酮配伍米索前列醇应用于治疗稽留流产与单用米索前列醇相比并未增加完全流产率,戊酸雌二醇配伍米索前列醇治疗稽留流产,疗效可靠,值得推广。
Objective To explore the value of estradiol valerate in combination with misoprostol in missed abortion. METHODS: From July 2011 to July 2012, 77 outpatients with gestational age ≤13 weeks missed abortion were enrolled in Beijing Jishuitan Hospital outpatient department. The patient’s intention to seek medical abortion was divided into two groups: 42 cases in group A and 42 cases in group B Cases), A group was randomly divided into A1 group (22 cases) and A2 group (20 cases). All patients were first oral estradiol valerate 5 mg, 3 times a day, and even for 3 d. Group A1 patients received oral misoprostol 600 μg on day 4; group A2 received mifepristone 150 mg on day 4, 600 μg of misoprostol on day 6; and group B received 35 patients undergoing radical curettage. To observe A1, A2, B group 3 curative effect. Results There was no significant difference between A1 and A2 group in the complete abortion rate, the amount of misoprostol, the time of discharging the fetal sac, the amount of vaginal bleeding after fetal sac delivery, and the time of menstrual resurgence (P> 0.05) The bleeding volume of the balloon was more than that of the A2 group, but the vaginal bleeding time after the balloon was discharged was less than that of the A2 group (P <0.05). A1 group compared with B group, A1 group after fetal vaginal discharge volume of vaginal bleeding slightly more than the B group (P <0.05), while the amount of fetal or intraoperative bleeding, postoperative bleeding time, No statistical significance (P> 0.05). Conclusion The combination of mifepristone and misoprostol in the treatment of missed abortion did not increase the rate of complete abortion compared with misoprostol alone. Estradiol valerate combined with misoprostol in treatment of missed abortion was reliable and worthy of promotion .