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目的:比较米索前列醇两种不同用药途径用于预防经阴道自然分娩产后出血的临床效果和不良反应。方法:2007年2月～2009年2月在宁波市妇女儿童医院分娩的产妇中,随机选择37～42周妊娠正常分娩、单胎头位、无妊娠合并症或并发症,未用过前列腺素抑制剂的产妇822例,随机分为米索前列醇舌下含化组、直肠用药组,每组各411例。舌下含化组于胎儿前肩娩出后立即舌下含化米索前列醇600μg;直肠用药组于胎儿前肩娩出后立即深部肛塞米索前列醇600μg,测量产后24 h出血量,分娩前后的血色素及红细胞压积,监测产妇分娩前后的血压、脉搏及寒战、发热、恶心、呕吐、头痛、腹泻等不良反应,如果阴道流血量较多则立即静脉推注缩宫素10 IU。结果:产后24 h阴道出血量舌下含化组明显低于直肠用药组,产后出血发生率舌下含化组低于直肠用药组,红细胞压积下降≥10%的比例、血色素下降≥30 g/L的百分比及加用缩宫素的比例,舌下含化组小于直肠组,差异有统计学意义(P<0.05)。寒战及发热的发生率舌下含化组高于直肠用药组(P<0.05)。结论:600μg米索前列醇预防经阴道自然分娩产后出血,舌下含化组效果优于直肠用药组,寒战及发热发生率舌下含化组高于直肠用药组。
OBJECTIVE: To compare the clinical effects and side effects of misoprostol with two different routes of administration for the prevention of postpartum hemorrhage in spontaneous vaginal delivery. Methods: From February 2007 to February 2009, women of childbearing at Ningbo Women and Children’s Hospital were randomly selected to deliver 37- to 42-week-old pregnancies with normal delivery, single head position, no pregnancy complications or complications, and no prostaglandin Inhibitors 822 cases of women, were randomly divided into misoprostol sublingual group, rectal administration group, each group of 411 cases. Sublingual group in the anterior shoulder immediately after delivery of the child sublingual misoprostol 600μg; rectal administration group in the anterior shoulder immediately after the delivery of anal anal misoprostol 600μg, 24 h postpartum hemorrhage measured before and after delivery Hematocrit and hematocrit, monitoring maternal blood pressure before and after delivery, pulse and chills, fever, nausea, vomiting, headache, diarrhea and other adverse reactions, if more vaginal bleeding immediately intravenous oxytocin 10 IU. Results: The amount of vaginal bleeding 24 hours postpartum was significantly lower than the rectal administration group, the incidence of postpartum hemorrhage sublingual group was lower than the rectal administration group, hematocrit decreased ≥ 10% of the proportion of hemoglobin decreased ≥ 30 g / L and the proportion of plus oxytocin, sublingual group is smaller than the rectal group, the difference was statistically significant (P <0.05). The incidence of chills and fever in the sublingual group was higher than that in the rectal group (P <0.05). CONCLUSION: 600μg misoprostol can prevent postpartum hemorrhage of natural vaginal delivery. The effect of sublingual group is better than that of rectal group. The incidence of chills and fever is higher in sublingual group than in rectal group.