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目的观察米非司酮配伍米索前列醇终止生化妊娠(无法证实官腔内或官腔外妊娠的阶段)的临床效果。方法对月经周期规律、停经≤49 d 的早孕期妇女,依据停经天数、血清人绒毛膜促性腺激素β亚单位(β-hCG)和阴道 B 超检查结果分组:生化妊娠(G_1)组、早期临床妊娠(G_2)组和临床妊娠(G_3)组,各500例。给予米非司酮口服,每次25 mg,每天2次,连用3 d,米索前列醇自口服首片米非司酮72 h 后,顿服600μg,之后留院观察6 h。定期随诊并每日记录观察日志,观察治疗结局并进行满意度自评。结果 (1)孕囊排出:G_1组妇女123例(24.6%,123/500)见孕囊排出,而G_2组、G_3组分别有62例(12.4%,62/500)和33例(6.6%,33/500)未见孕囊排出。(2)治疗失败:G_1～G_3组需手术干预者分别为1例(0.2%,1/500)、20例(4.0%,20/500)和79例(15.8%,79/500),收住院者分别为5例(1.0%,5/500)、4例(0.8%,4/500)和0。(3)阴道出血:G_1～G_3组服用米非司酮期间阴道出血者分别为272例(54.4%,272/500)、141(28.2%,141/500)和87例(17.4%,87/500),3组比较,差异有统计学意义(P<0.05);平均阴道出血时间,G_1组为(5.8±1.5)d,G_2组(9.0±2.9)d,G_3组(14.3±5.9)d,3组比较,差异有统计学意义(P<0.05)。(4)副作用:3组妇女恶心、呕吐、腹痛的发生率高,但程度均较轻;头晕、头痛和腹泻在3组中发生均较少。(5)月经恢复:G_1组有97.2%(486/500)的妇女、G_2组有90.4%(452/500)的妇女月经能如期复潮,G_3组有86.6%(433/500)的妇女月经也能如期复潮。(6)自评满意度:G_1组为99.8%(499/500)、G_2组97.0%(485/500)、G_3组为73.8%(369/500)。结论米非司酮配伍米索前列醇终止生化妊娠是安全、有效的方法,无需等待官腔内临床妊娠被确定后再处理;对终止早期临床妊娠也是较好的方法。
Objective To observe the clinical effect of mifepristone combined with misoprostol to terminate biochemical pregnancy (unable to confirm the stage of intrauterine or extrauterine pregnancy). Methods The women with early menses menstrual cycle ≤ 49 d menopausal women were divided into three groups according to the days of menopause, serum β-hCG and vaginal ultrasonography: group of biochemical pregnancy (G_1), early stage Clinical pregnancy (G_2) group and clinical pregnancy (G_3) group, each 500 cases. Given mifepristone orally, each 25 mg twice daily for 3 d, misoprostol oral self-administration of mifepristone 72 h, Dayton served 600 g, then stay in hospital for 6 h. Regular follow-up and daily observation of the observation log to observe the treatment outcome and satisfaction self-assessment. Results: (1) The gestational sac was expelled: 123 cases (24.6%, 123/500) of G_1 group showed gestational sac excretion while 62 cases (12.4%, 62/500) and 33 cases (6.6% , 33/500) no gestational sac discharge. (2) The failure of treatment: 1 case (0.2%, 1/500), 20 cases (4.0%, 20/500) and 79 cases (15.8%, 79/500) received G- There were 5 hospitalizations (1.0%, 5/500), 4 (0.8%, 4/500) and 0 hospitalizations. (3) Vaginal bleeding: 272 cases (54.4%, 272/500), 141 (28.2%, 141/500) and 87 cases (17.4%, 87 / (P <0.05). The mean vaginal bleeding time was (5.8 ± 1.5) days in G_1 group, 9.0 ± 2.9 days in G_2 group and (14.3 ± 5.9) days in G 3 group , 3 groups, the difference was statistically significant (P <0.05). (4) side effects: the incidence of nausea, vomiting, abdominal pain in 3 groups of women is high, but to a lesser degree; dizziness, headache and diarrhea occur less frequently in 3 groups. (5) Menstruation recovery: 97.2% (486/500) women in G_1 group, 90.4% (452/500) women in G_2 group had menstruation regurgitation as expected, and 86.6% (433/500) women in G_3 group menstruated Also on schedule tide. (6) Self-assessment satisfaction: 99.8% (499/500) in G_1 group, 97.0% (485/500) in G_2 group and 73.8% (369/500) in G_3 group. Conclusion Mifepristone combined with misoprostol termination of biochemical pregnancy is a safe and effective method, without waiting for the official intrauterine pregnancy was confirmed and then treated; the termination of early clinical pregnancy is also a better method.