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目的;比较米非司酮合并米索前列醇与利凡诺羊膜腔内注射终止16～24周妊娠的临床效果及各自的优缺点。方法:将来自上海市13所医院的829例孕16～24周要求终止妊娠的妇女,随机分成2种不同的治疗组。组Ⅰ(双米组):415例,米非司酮 100mg/qd连服两天(总量 200mg),第 3天晨阴道内放置米索前列醇 0.4mg,每 12小时重复 一次,最多3次;组Ⅱ(利凡诺组):414例,羊膜腔内注射利凡诺100mg,不加任何辅助方法,胎儿胎盘娩出后常规清宫。结果:两组流产成功率分别为91.6％和92.3％,两组间的差异有显著性意义(P>0.05);两组流产成功者用药至胎儿排出时间分别为57.69±7.85小时和46.92±10.06小时,两组间的差异有显著性意义(P<0.01);两组流产成功者产程分别为8.09±6.97小时和11.4±8.28小时,双米组产程时间明显短于利凡诺组,P>0.001;流产后阴道流血量和阴道流血时间两组间差异无显著性意义(P>0.05);双米组胃肠道反应和头痛、眩晕等副反应发生率高于利凡诺组(P<0.05),但无需处理。结论:口服米非司酮200mg合并阴道放置米索前列醇是较好的药物终止16～24周妊娠的方法,可以作为一种常规方法在有条件的医院中应用。
Objective To compare the clinical efficacy of mifepristone combined with misoprostol and rivanol amniocentesis in the termination of 16-24 weeks gestation and their respective advantages and disadvantages. METHODS: A total of 829 women who requested termination of pregnancy at 16-24 weeks of gestation from 13 hospitals in Shanghai were randomly assigned to two different treatment groups. Group Ⅰ (two meters): 415 cases, mifepristone 100mg / qd even for two days (total 200mg), the first 3 days morning misoprostol 0.4mg, every 12 hours to repeat, up to 3 Group II (Rivaroxone group): 414 cases, with amniotic injection of rivanol 100mg, without any auxiliary method, the fetus was routinely delivered after the placenta was delivered. Results: The successful rates of abortion in both groups were 91.6% and 92.3%, respectively, with significant difference between the two groups (P> 0.05). The time from successful abortion to fetus in both groups were 57.69 ± 7.85 hours and 46.92 ± 10.06 Hour, the difference between the two groups was significant (P <0.01); the successful course of labor in two groups were 8.09 ± 6.97 hours and 11.4 ± 8.28 hours respectively, and the duration of labor was shorter in two-meter group than in rivanol group, P> 0.001). The vaginal bleeding and vaginal bleeding time after abortion had no significant difference between the two groups (P> 0.05). The incidence of gastrointestinal reactions and headache and dizziness in the two-meter group was higher than that in the rivanol group (P < 0.05), but without treatment. CONCLUSIONS: Oral mifepristone 200 mg combined with vaginal misoprostol is the preferred method of discontinuing pregnancy for 16 to 24 weeks and can be used as a routine method in a conditional hospital.