米非司酮配伍米索前列醇加用辣椒素終止早期妊娠的療效觀察

藺瑾

(云南省第三人民醫(yī)院婦產(chǎn)科，云南昆明　650011)

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·論著·

米非司酮配伍米索前列醇加用辣椒素終止早期妊娠的療效觀察

藺瑾

(云南省第三人民醫(yī)院婦產(chǎn)科，云南昆明650011)

摘要目的：觀察米非司酮配伍米索前列醇加用辣椒素終止早期妊娠的療效。方法： 選擇2012年2月—2014年2月在云南省第三人民醫(yī)院就診的孕齡在10周內(nèi)要求終止妊娠的婦女400例，隨機(jī)分為研究組和對(duì)照組，每組200例。2組均采用藥物流產(chǎn)，服藥劑量及方法相同；研究組加用辣椒素口服。比較2組的流產(chǎn)率、胚囊排出時(shí)間、陰道流血時(shí)間及月經(jīng)復(fù)潮時(shí)間。結(jié)果：研究組完全流產(chǎn)率高于對(duì)照組(P<0.05)；研究組胚囊排出時(shí)間、陰道流血時(shí)間及月經(jīng)復(fù)潮時(shí)間均顯著短于對(duì)照組(P<0.05)。結(jié)論：辣椒素配合流產(chǎn)藥物終止早期妊娠能提高完全流產(chǎn)率，縮短陰道流血時(shí)間，減少子宮出血，提高藥物流產(chǎn)的治療效果。

關(guān)鍵詞藥物流產(chǎn)；辣椒素；療效

米索前列醇配伍米非司酮是目前臨床上廣泛應(yīng)用的終止早期妊娠的藥物。藥物流產(chǎn)可避免宮腔操作，減少人工流產(chǎn)手術(shù)后并發(fā)癥的發(fā)生，因此易被要求終止妊娠的婦女接受[1]。但是，藥物流產(chǎn)也有不足，如陰道流血時(shí)間長、胚囊排出時(shí)間長、完全流產(chǎn)率低等[2]。本研究通過觀察胚囊排出時(shí)間、陰道流血時(shí)間和流產(chǎn)率等，探討米索前列醇配伍米非司酮加用辣椒素終止早期妊娠的效果。

1資料與方法

1.1一般資料選擇2012年2月—2014年2月在云南省第三人民醫(yī)院要求終止妊娠的早孕婦女400例，經(jīng)B超檢查與婦科檢查確診為宮內(nèi)妊娠，且肝功能、血尿常規(guī)、出凝血時(shí)間均正常；排除急慢性疾病，無應(yīng)用辣椒素的禁忌證，無藥物過敏與重度陰道炎、陰道流血。400例患者的年齡18～38歲，中位年齡27.5歲；孕次1～4次，平均2.9次；妊娠天數(shù)32～55 d，平均43.5 d。將400例要求終止妊娠的婦女隨機(jī)分為2組，每組200例。對(duì)照組給予米非司酮、米索前列醇；研究組在應(yīng)用對(duì)照組相同藥物的基礎(chǔ)上加用辣椒素。研究組患者對(duì)加用辣椒素均知情同意。

1.2方法對(duì)照組和研究組均應(yīng)用米非司酮(國藥準(zhǔn)字:H10950203，上海新華聯(lián)制藥有限公司)和米索前列醇(國藥準(zhǔn)字：H20094136，上海新華聯(lián)制藥有限公司)進(jìn)行藥物流產(chǎn)。第1天頓服米非司酮100 mg，連續(xù)服用2 d；第3次服用米非司酮后12 h經(jīng)陰道置入米索前列醇60 mg。研究組服用米索前列醇2 h后服用辣椒素含片(國藥準(zhǔn)字：Z36021461，江西同濟(jì)堂藥業(yè))，每天6 mg，服用1周。

2結(jié)果

研究組完全流產(chǎn)率高于對(duì)照組(P<0.05)，見表1。研究組胚囊排出時(shí)間、陰道流血時(shí)間、月經(jīng)復(fù)潮時(shí)間均短于對(duì)照組(P<0.05)，見表2。

表1　2組流產(chǎn)效果比較　(n，%)

注：與對(duì)照組比較，*P<0.05

表2　2組胚囊排出時(shí)間、陰道流血時(shí)間及

注：與對(duì)照組比較，*P<0.05

3討論

米非司酮是一種甾體類抗孕激素制劑，其與前列腺素類似物聯(lián)合用于終止早期妊娠安全有效、不良反應(yīng)少[3]。目前對(duì)于前列腺素的作用已有廣泛研究[4-5]；而辣椒素可以促進(jìn)內(nèi)源性前列腺素釋放，與流產(chǎn)及產(chǎn)后子宮收縮密切相關(guān)。研究[6]表明，辣椒素可以促進(jìn)妊娠大鼠的子宮收縮，導(dǎo)致流產(chǎn)及早產(chǎn)。還有研究[7]表明，宮頸上的辣椒素受體被激活后，直接參與宮頸成熟軟化及分娩活動(dòng)。以往，辣椒素被廣泛用于減肥及鎮(zhèn)痛，本研究利用辣椒素軟化宮頸及促進(jìn)子宮收縮的作用，配伍流產(chǎn)藥物用于終止早期妊娠。結(jié)果表明，研究組完全流產(chǎn)率高于對(duì)照組(P<0.05)，研究組胚囊排出時(shí)間、陰道流血時(shí)間、月經(jīng)復(fù)潮時(shí)間均顯著短于對(duì)照組(P<0.05)。

綜上所述，辣椒素可以有效增強(qiáng)米索前列醇的促宮縮作用，提高終止妊娠婦女的完全流產(chǎn)率，縮短藥物流產(chǎn)時(shí)胚囊排出時(shí)間及流產(chǎn)后陰道流血時(shí)間。

參考文獻(xiàn)

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Observation on Efficacy of Additional Capsaicin on the Basis of Mifepristone Combined with Misoprostol in Terminating Early Pregnancy

LINJin

DepartmentofGynecologyandObstetrics,TheThirdPeople′sHospitalofYunnanProvince,Kunming650011,China

AbstractObjective：To observe the efficacy of additional capsaicin on the basis of mifepristone combined with misoprostol in terminating early pregnancy. Methods:A total of 400 women with gestational age at 10 weeks, who wanted to terminate the pregnancy in the third people′s hospital of Yunan province from Feb 2012 to Feb 2014, were randomly divided into the control group and the study group,with 200 cases in each group.Both the groups were given drug-induced abortion with same dosage and method.The study group was added with capsaicin.The abortion rate,the embryo sac discharge time,vaginal bleeding time and menstruation recovery time of the two groups were compared with each other. Results: The complete abortion rate in the study group was higher than that in the control group(P<0.05).The embryo sac discharge time,the vaginal bleeding time,menstruation recovery time in the study group were significantly shorter than those in the control group(P<0.05). Conclusions: For terminating early pregnancy, capsaicin combined with abortion medications could shorten the period of vaginal bleeding, decrease the uterine bleeding volume, and improve the efficacy of drug-induced abortion.

Key WordsDrug-induced abortion；Capsaicin；Efficacy

中圖分類號(hào)R714.2

文獻(xiàn)標(biāo)識(shí)碼A