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目的基于疾病负担,循证评价与遴选我国乡镇卫生院人工流产基本药物。方法应用本系列研究之二制定的基本药物循证评价与遴选标准、方法、流程,参考国内外循证或权威指南的推荐意见,结合国内相关临床研究证据,循证评价并推荐相关药物。主要采用RevMan 5.1、GRADEpro 3.6等软件处理数据、评价证据质量。结果①共纳入4个指南,含循证指南2个。②指南涉及人工流产基本药物8种及手术流产后所用抗生素4种。③药物流产基本药物遴选根据WHO EML(2011版)、NEML(2009版)、中国国家处方集(2010年版)、指南推荐及证据数量和质量,强推荐米非司酮、米索前列醇、缩宫素,不推荐前列腺素。④缩宫素、米非司酮、米索前列醇国内均有相关文献,并有相应剂型和规格上市。⑤国内研究表明:米非司酮配伍米索前列醇和缩宫素安全有效、简便易行、可接受性较好。结论人工流产推荐用药:①米非司酮配伍米索前列醇。米非司酮片25～50 mg,每日2次,连服2～3日,总量150 mg。米索前列醇0.6 mg,在服用米非司酮36～48小时后,空腹口服。②缩宫素,药流胎盘娩出后肌肉注射5～10 U,用于减少药流阴道出血量及缩短出血时间。建议统一规范判效标准,提高临床研究设计和实施质量。
Objective Based on the burden of disease, evidence-based evaluation and selection of China’s township hospitals abortion essential drugs. Methods Based on the recommended evidence-based evaluation and selection criteria, methods and procedures of basic evidence-based medicine developed in this series of studies, with reference to the recommendations of evidence-based or authoritative guidelines both at home and abroad, combined with evidence from clinical studies in China, we evaluated and recommended relevant evidence-based medicine. The main use of RevMan 5.1, GRADEpro 3.6 software such as data processing, evaluation of evidence of quality. Results ① A total of 4 guides were included, including 2 evidence-based guides. ② The guidelines involved 8 kinds of essential drugs for induced abortion and 4 kinds of antibiotics used after surgical abortion. (3) The selection of essential drugs for medical abortion is highly recommended. According to the WHO EML (2011 edition), NEML (2009 edition), China National Formulary (2010 edition), the guideline recommendation and the quantity and quality of evidence, mifepristone, misoprostol, Uterine hormone, not recommended prostaglandin. ④ oxytocin, mifepristone, misoprostol domestic relevant literature, and the appropriate dosage form and specifications listed. ⑤ domestic research shows that: mifepristone with misoprostol and oxytocin safe and effective, easy, acceptable. Conclusion Induced abortion recommended drugs: ① mifepristone with misoprostol. Mifepristone tablets 25 ~ 50 mg, 2 times a day, and even served 2 to 3 days, the total 150 mg. Misoprostol 0.6 mg, taking mifepristone 36 to 48 hours after fasting oral. ② oxytocin, medical abortion placenta after intramuscular injection of 5 ~ 10 U, used to reduce the flow of vaginal bleeding and shorten the bleeding time. It is recommended to standardize the standard of judgment and improve the quality of clinical research design and implementation.