中晚期妊娠三種引產(chǎn)方案臨床療效與宮內(nèi)妊娠物殘留治療方法的探討
發(fā)布時(shí)間：2018-08-16 08:56
【摘要】：研究背景全世界中期妊娠引產(chǎn)占所有人工終止妊娠的10%～15%[1],但其并發(fā)癥占所有引產(chǎn)患者的2/3[2]。2015年,我國(guó)有985萬(wàn)例人工終止妊娠[3]。盡管中晚期妊娠引產(chǎn)的并發(fā)癥遠(yuǎn)高于早期妊娠流產(chǎn)[4,5],但我國(guó)中期妊娠引產(chǎn)仍占人工終止妊娠的5%[6]。世界足月妊娠分娩宮內(nèi)妊娠物殘留的發(fā)生率大約為1%,在流產(chǎn)或引產(chǎn)時(shí)發(fā)生率明顯增加[7]。國(guó)內(nèi)外報(bào)道中期妊娠引產(chǎn)宮內(nèi)妊娠物殘留的發(fā)生率在2.3%～21.3%不等[8-12]。清宮是我國(guó)目前常用的治療宮內(nèi)妊娠物殘留的方法。然而清宮會(huì)引起一系列的近遠(yuǎn)期并發(fā)癥如盆腔炎、子宮穿孔、宮頸裂傷、宮腔粘連、不孕等[13-16]。而事實(shí)上妊娠終止后子宮復(fù)舊的過(guò)程,同樣可以讓蛻膜等妊娠物自行排出,因此,引產(chǎn)后不加選擇地實(shí)施清宮術(shù)是否適當(dāng),目前需要解決的問(wèn)題。第一部分中晚期妊娠三種引產(chǎn)方案的臨床療效分析[目的]比較中晚期妊娠三種引產(chǎn)方法的臨床療效。[方法]回顧性分析2014年1月至2015年12月到我科行中晚期妊娠引產(chǎn)的337例孕產(chǎn)婦的臨床資料,根據(jù)引產(chǎn)方法將研究對(duì)象分成三組:乳酸依沙吖啶配伍米非司酮組(簡(jiǎn)稱利凡諾組)224例,米索前列醇配伍米非司酮組(簡(jiǎn)稱米索組)82例,水囊配伍米非司酮組(簡(jiǎn)稱水囊組)31例。[結(jié)果](1)利凡諾組引產(chǎn)排胎時(shí)間小于米索組((38.6±12.9)VS(51.5±17.1)小時(shí),P0.001)與水囊組((49.6±19.3)小時(shí),P=0.012);米索組與水囊組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.949)。(2)總引產(chǎn)成功率為92.6%。利凡諾組引產(chǎn)成功率高于米索組和水囊組(96.9%VS 82.9%和87.1%,χ2=18.499,P0.001);米索組和水囊組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(3)利凡諾組宮內(nèi)殘留妊娠物均徑長(zhǎng)于米索組((38.6±23.5)mm VS(28.9±16.1)mm,P0.001);水囊組(29.3±20.7)mm與利凡諾組和米索組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。三組宮內(nèi)妊娠物殘留率比較差異無(wú)統(tǒng)計(jì)學(xué)意義(χ2=1.722,P=0.423)。米索組清宮率高于利凡諾組和水囊組(47.6%VS 32.6%和32.3%,P0.05),利凡諾組和水囊組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(4)三組血紅蛋白變化水平、陰道流血時(shí)間和月經(jīng)復(fù)潮時(shí)間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。[結(jié)論]三種引產(chǎn)方案均能有效終止妊娠。雖然利凡諾組引產(chǎn)排胎時(shí)間較短,宮內(nèi)殘留妊娠物體積較大,但三種引產(chǎn)方案宮內(nèi)妊娠物殘留率和預(yù)后比較無(wú)差異,且米索組清宮率高于另外兩組,因此尚不能認(rèn)為三種引產(chǎn)方案何者優(yōu)。第二部分中晚期妊娠引產(chǎn)后清宮率及清宮的相關(guān)危險(xiǎn)因素分析[目的]探討中晚期妊娠引產(chǎn)后清宮率,分析引產(chǎn)后清宮的危險(xiǎn)因素。[方法]研究對(duì)象同第一部分。根據(jù)引產(chǎn)后清宮與否將研究對(duì)象分為清宮組(122例)和未清宮組(215例)。[結(jié)果](1)本研究清宮率為36.2%。(2)清宮組孕齡小于未清宮組((20.3±5.3)VS(23.4±6.5)周,t=4.679,P0.001)。清宮組引產(chǎn)排胎時(shí)間長(zhǎng)于未清宮組((44.3±17.7)VS(36.2±12.7)小時(shí),t=2.128,P0.001)。兩組宮內(nèi)殘留妊娠物均徑比較差異無(wú)統(tǒng)計(jì)學(xué)意義(t=0.556,P=0.579)。(3)孕齡是清宮的保護(hù)因素(優(yōu)勢(shì)比=0.920,95%可信區(qū)間0.885-0.956,P0.001),引產(chǎn)排胎時(shí)間是清宮的危險(xiǎn)因素(優(yōu)勢(shì)比=1.013,95%可信區(qū)間1.001-1.026,P=0.036)。在控制了混雜因素后,孕齡仍是清宮的保護(hù)因素(優(yōu)勢(shì)比=0.932,95%可信區(qū)間0.888-0.979,P=0.005),引產(chǎn)排胎時(shí)間不再是清宮的危險(xiǎn)因素(優(yōu)勢(shì)比=1.006,95%可信區(qū)間0.991-1.020,P=0.444),而宮內(nèi)殘留妊娠物均徑成為了清宮的危險(xiǎn)因素(優(yōu)勢(shì)比=1.012,95%可信區(qū)間1.000-1.024,P=0.044)。[結(jié)論]引產(chǎn)后清宮與孕齡、引產(chǎn)排胎時(shí)間及宮內(nèi)殘留妊娠物均徑密切相關(guān),孕齡越小、引產(chǎn)排胎時(shí)間越長(zhǎng)及宮內(nèi)殘留妊娠物均徑越大,清宮的風(fēng)險(xiǎn)越高。第三部分 清宮與期待治療宮內(nèi)妊娠物殘留預(yù)后及其相關(guān)并發(fā)癥的危險(xiǎn)因素研究[目的]比較兩種方法治療宮內(nèi)妊娠物殘留的預(yù)后、再次妊娠結(jié)局及并發(fā)癥,分析治療后并發(fā)癥發(fā)生的相關(guān)危險(xiǎn)因素。[方法]回顧性分析2014年1月至2015年12月在我科行中晚期妊娠引產(chǎn)并因?qū)m內(nèi)妊娠物殘留而接受期待觀察或清宮治療的270例孕產(chǎn)婦的臨床資料。[結(jié)果](1)清宮組血紅蛋白變化水平中位數(shù)大于期待治療組(5 VS 2 g/L,Z=-2.960,P=0.003)。清宮組陰道流血時(shí)間中位數(shù)小于期待觀察組(14 VS 17天,Z=2.824,P=0.005)。清宮組陰道流血時(shí)間超過(guò)42天者發(fā)生率高于期待觀察組(6.1%VS 1.3%,P=0.040)。兩組月經(jīng)復(fù)潮時(shí)間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(r=0.570,P=0.569)。兩組月經(jīng)復(fù)潮時(shí)間超過(guò)60天者發(fā)生率比較差異無(wú)統(tǒng)計(jì)學(xué)意義(χ2=0.076,P=0.783)。(2)清宮組第二周β-hCG對(duì)數(shù)值大于期待觀察組(χ2=10.588,P=0.009)。兩組第一周和第三周β-hCG對(duì)數(shù)值比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組β-hCG值轉(zhuǎn)陰時(shí)間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(t=2.088,=0.057)。(3)清宮是引產(chǎn)后并發(fā)癥發(fā)生的危險(xiǎn)因素(優(yōu)勢(shì)比=10.60,95%可信區(qū)間2.36-47.66,P =0.002)�？刂苹祀s因素后,清宮仍然是引產(chǎn)后并發(fā)癥發(fā)生的危險(xiǎn)因素(優(yōu)勢(shì)比=18.26,95%可信區(qū)間 3.57-93.42,P0.001)。(4)兩組計(jì)劃妊娠者再次妊娠自然受孕率、再次妊娠后活產(chǎn)率和流產(chǎn)率比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。[結(jié)論]與期待觀察相比,清宮并不能減少陰道流血時(shí)間,對(duì)血β-hCG下降速度、月經(jīng)復(fù)潮時(shí)間及再次妊娠結(jié)局無(wú)明顯影響,反而會(huì)增加血紅蛋白下降水平,且會(huì)增加感染、盆腔痛、異常子宮出血等并發(fā)癥的發(fā)生風(fēng)險(xiǎn)。
[Abstract]:Background Mid-term pregnancy induced abortion accounts for 10% to 15% of all induced abortions in the world, but its complications account for 2/3 of all induced abortions. In 2015, there were 9.85 million induced abortions in China [3]. 5%[6]. The incidence of intrauterine pregnancy residue in full-term pregnancy is about 1% in the world. The incidence of intrauterine pregnancy residue in abortion or induced labor is significantly increased [7]. It can cause a series of short-term and long-term complications such as pelvic inflammation, uterine perforation, cervical laceration, intrauterine adhesion, infertility, etc. [13-16]. In fact, the process of uterine involution after termination of pregnancy can also allow decidua and other pregnant materials to be discharged by themselves. [Methods] The clinical data of 337 pregnant and lying-in women who were admitted to our department from January 2014 to December 2015 were retrospectively analyzed. The subjects were divided into three groups according to the induced labor method: ethacridine lactate. Results (1) The induced abortion time of Rivanol group was shorter than that of Misoprostol group ((38.6+12.9) VS (51.5+17.1) hours, P 0.001) and water bag group ((49.6+19.3) hours, P = 0.012). There was no significant difference between misoprostol group and water sac group (P = 0.949). (2) The total success rate of induced labor was 92.6%. The success rate of induced labor in rivanol group was higher than that in misoprostol group and water sac group (96.9% VS 82.9% and 87.1%, 2 = 18.499, P 0.001); there was no significant difference between misoprostol group and water sac group (P 0.05). (3) The diameter of intrauterine pregnancy residue in rivanol group was longer than that in metre group. There was no significant difference in the residual rate of intrauterine pregnancy among the three groups (2 = 1.722, P = 0.423). The clearance rate of misoprostol group was higher than that of rivanol group and water bag group (47.6% VS 32.6% and 32.3%, P 0.05). There was no significant difference between the normal group and the water bag group (P 0.05). (4) There was no significant difference in the hemoglobin level among the three groups, the time of vaginal bleeding and menstruation (P 0.05). [Conclusion] All the three abortion schemes can effectively terminate pregnancy. There was no difference in the residue rate and prognosis of intrauterine pregnancy among the three abortion schemes, and the clearance rate of misoprostol group was higher than that of the other two groups. The second part was about the clearance rate of mid-late pregnancy after induction of labor and the analysis of related risk factors. [Methods] The study subjects were the same as the first part. The subjects were divided into clear uterus group (122 cases) and unclear uterus group (215 cases). [Results] (1) The rate of clear uterus in this study was 36.2%. (2) The gestational age of clear uterus group was less than that of unclear uterus group ((20.3 + 5.3) VS (23.4 + 6.5) weeks, t = 4.679, P 0.001). There was no significant difference in the diameter of intrauterine residual pregnancies between the two groups (t = 0.556, P = 0.579). (3) Pregnancy age was the protective factor of uterine clearance (odds ratio = 0.920, 95% confidence interval 0.885-0.956, P 0.001), and the time of induced abortion and abortion were the risk factors of uterine clearance (odds ratio = 1.013, 95% confidence). After controlling for confounding factors, gestational age was still a protective factor for uterine clearance (odds ratio = 0.932, 95% CI 0.888-0.979, P = 0.005). The time of induced abortion and abortion was no longer a risk factor for uterine clearance (odds ratio = 1.006, 95% CI 0.991-1.020, P = 0.444). The diameter of intrauterine residual pregnancy was a risk factor for uterine clearance. [Conclusion] After induction of labor, uterine clearance is closely related to gestational age, time of induction and abortion and the diameter of intrauterine residual pregnancy. The younger the gestational age, the longer the time of induction and abortion and the bigger the diameter of intrauterine residual pregnancy, the higher the risk of uterine clearance. [Objective] To compare the prognosis of intrauterine pregnancy remnants treated with two methods, the outcome of second pregnancy and complications, and analyze the risk factors of complications after treatment. [Results] (1) The median hemoglobin level in the clearance group was higher than that in the expectant treatment group (5 VS 2 g/L, Z = - 2.960, P = 0.003). The median vaginal bleeding time in the clearance group was less than that in the expectant observation group (14 VS 17 days, Z = 2.824, P = 0.005). There was no significant difference in the time of menstruation between the two groups (r = 0.570, P = 0.569). There was no significant difference in the incidence of menstruation over 60 days between the two groups (2 = 0.076, P = 0.783). (2) The logarithm of beta-hCG in the second week of the uterine clearance group was higher than that in the expected observation group (2 = 10.569). There was no significant difference in the logarithmic value of beta-hCG between the two groups at the first week and the third week (P 0.05). There was no significant difference in the negative time of beta-hCG between the two groups (t = 2.088, = 0.057). (3) Clearance of uterus was a risk factor for postpartum complications (odds ratio = 10.60, 95% confidence interval 2.36-47.66, P = 0.002). The uterus was still a risk factor for complications after induction of labor (odds ratio = 18.26, 95% CI 3.57-93.42, P 0.001). (4) There was no significant difference in the natural conception rate, live birth rate and abortion rate of the planned pregnancies between the two groups (P 0.05). [Conclusion] Clearance of uterus did not reduce vaginal bleeding compared with expected observation. Meanwhile, there was no significant effect on the decrease rate of blood beta-hCG, the time of menstruation and the outcome of second pregnancy. On the contrary, it increased the level of hemoglobin decrease, and increased the risk of complications such as infection, pelvic pain and abnormal uterine bleeding.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R719.3
本文編號(hào)：2185509
[Abstract]:Background Mid-term pregnancy induced abortion accounts for 10% to 15% of all induced abortions in the world, but its complications account for 2/3 of all induced abortions. In 2015, there were 9.85 million induced abortions in China [3]. 5%[6]. The incidence of intrauterine pregnancy residue in full-term pregnancy is about 1% in the world. The incidence of intrauterine pregnancy residue in abortion or induced labor is significantly increased [7]. It can cause a series of short-term and long-term complications such as pelvic inflammation, uterine perforation, cervical laceration, intrauterine adhesion, infertility, etc. [13-16]. In fact, the process of uterine involution after termination of pregnancy can also allow decidua and other pregnant materials to be discharged by themselves. [Methods] The clinical data of 337 pregnant and lying-in women who were admitted to our department from January 2014 to December 2015 were retrospectively analyzed. The subjects were divided into three groups according to the induced labor method: ethacridine lactate. Results (1) The induced abortion time of Rivanol group was shorter than that of Misoprostol group ((38.6+12.9) VS (51.5+17.1) hours, P 0.001) and water bag group ((49.6+19.3) hours, P = 0.012). There was no significant difference between misoprostol group and water sac group (P = 0.949). (2) The total success rate of induced labor was 92.6%. The success rate of induced labor in rivanol group was higher than that in misoprostol group and water sac group (96.9% VS 82.9% and 87.1%, 2 = 18.499, P 0.001); there was no significant difference between misoprostol group and water sac group (P 0.05). (3) The diameter of intrauterine pregnancy residue in rivanol group was longer than that in metre group. There was no significant difference in the residual rate of intrauterine pregnancy among the three groups (2 = 1.722, P = 0.423). The clearance rate of misoprostol group was higher than that of rivanol group and water bag group (47.6% VS 32.6% and 32.3%, P 0.05). There was no significant difference between the normal group and the water bag group (P 0.05). (4) There was no significant difference in the hemoglobin level among the three groups, the time of vaginal bleeding and menstruation (P 0.05). [Conclusion] All the three abortion schemes can effectively terminate pregnancy. There was no difference in the residue rate and prognosis of intrauterine pregnancy among the three abortion schemes, and the clearance rate of misoprostol group was higher than that of the other two groups. The second part was about the clearance rate of mid-late pregnancy after induction of labor and the analysis of related risk factors. [Methods] The study subjects were the same as the first part. The subjects were divided into clear uterus group (122 cases) and unclear uterus group (215 cases). [Results] (1) The rate of clear uterus in this study was 36.2%. (2) The gestational age of clear uterus group was less than that of unclear uterus group ((20.3 + 5.3) VS (23.4 + 6.5) weeks, t = 4.679, P 0.001). There was no significant difference in the diameter of intrauterine residual pregnancies between the two groups (t = 0.556, P = 0.579). (3) Pregnancy age was the protective factor of uterine clearance (odds ratio = 0.920, 95% confidence interval 0.885-0.956, P 0.001), and the time of induced abortion and abortion were the risk factors of uterine clearance (odds ratio = 1.013, 95% confidence). After controlling for confounding factors, gestational age was still a protective factor for uterine clearance (odds ratio = 0.932, 95% CI 0.888-0.979, P = 0.005). The time of induced abortion and abortion was no longer a risk factor for uterine clearance (odds ratio = 1.006, 95% CI 0.991-1.020, P = 0.444). The diameter of intrauterine residual pregnancy was a risk factor for uterine clearance. [Conclusion] After induction of labor, uterine clearance is closely related to gestational age, time of induction and abortion and the diameter of intrauterine residual pregnancy. The younger the gestational age, the longer the time of induction and abortion and the bigger the diameter of intrauterine residual pregnancy, the higher the risk of uterine clearance. [Objective] To compare the prognosis of intrauterine pregnancy remnants treated with two methods, the outcome of second pregnancy and complications, and analyze the risk factors of complications after treatment. [Results] (1) The median hemoglobin level in the clearance group was higher than that in the expectant treatment group (5 VS 2 g/L, Z = - 2.960, P = 0.003). The median vaginal bleeding time in the clearance group was less than that in the expectant observation group (14 VS 17 days, Z = 2.824, P = 0.005). There was no significant difference in the time of menstruation between the two groups (r = 0.570, P = 0.569). There was no significant difference in the incidence of menstruation over 60 days between the two groups (2 = 0.076, P = 0.783). (2) The logarithm of beta-hCG in the second week of the uterine clearance group was higher than that in the expected observation group (2 = 10.569). There was no significant difference in the logarithmic value of beta-hCG between the two groups at the first week and the third week (P 0.05). There was no significant difference in the negative time of beta-hCG between the two groups (t = 2.088, = 0.057). (3) Clearance of uterus was a risk factor for postpartum complications (odds ratio = 10.60, 95% confidence interval 2.36-47.66, P = 0.002). The uterus was still a risk factor for complications after induction of labor (odds ratio = 18.26, 95% CI 3.57-93.42, P 0.001). (4) There was no significant difference in the natural conception rate, live birth rate and abortion rate of the planned pregnancies between the two groups (P 0.05). [Conclusion] Clearance of uterus did not reduce vaginal bleeding compared with expected observation. Meanwhile, there was no significant effect on the decrease rate of blood beta-hCG, the time of menstruation and the outcome of second pregnancy. On the contrary, it increased the level of hemoglobin decrease, and increased the risk of complications such as infection, pelvic pain and abnormal uterine bleeding.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R719.3
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 鄒倩;王燕;熊俊;郎雁;張伶俐;;不同方案治療流產(chǎn)后宮腔殘留的療效觀察[J];中國(guó)計(jì)劃生育學(xué)雜志;2016年07期
2 賈小文;盧文華;王世艷;;中期引產(chǎn)清宮術(shù)后即日服用優(yōu)思明的臨床效果觀察[J];中國(guó)計(jì)劃生育學(xué)雜志;2016年05期
3 廖敏;鐘俊妍;;水囊聯(lián)合米索前列醇在中孕引產(chǎn)中的效果安全研究[J];中國(guó)醫(yī)藥指南;2016年13期
4 武向飛;黎荔;龍茜;岳錦春;;已婚女性人工流產(chǎn)術(shù)后放置宮內(nèi)節(jié)育器的影響因素分析[J];中國(guó)計(jì)劃生育學(xué)雜志;2016年04期
5 孫麗梅;;米非司酮配伍米索前列醇、利凡諾終止中期妊娠的療效觀察[J];實(shí)用婦科內(nèi)分泌電子雜志;2015年09期
6 錢金鳳;王彩燕;諸葛聽(tīng);黃紫蓉;;米非司酮配伍米索前列醇終止16～24周妊娠的臨床研究[J];中國(guó)計(jì)劃生育學(xué)雜志;2015年07期
7 楊娟;;米非司酮配伍米索前列醇聯(lián)合依沙吖啶羊膜腔注射引產(chǎn)的臨床效果觀察[J];中國(guó)計(jì)劃生育學(xué)雜志;2015年01期
8 董慶雙;;4種藥物終止中期妊娠方法療效的臨床觀察和比較[J];中國(guó)醫(yī)藥指南;2014年32期
9 夏春;田軍;;利凡諾聯(lián)合小水囊在中期妊娠引產(chǎn)中的效果分析[J];吉林醫(yī)學(xué);2014年26期
10 呂淑芳;景慧萍;;米非司酮配伍米索前列醇終止10~16周妊娠的臨床觀察[J];中國(guó)婦幼保健;2014年18期
相關(guān)碩士學(xué)位論文 前1條
1 曾成英;三種中期妊娠引產(chǎn)方案與胎盤殘留影響因素探討[D];暨南大學(xué);2011年
，本文編號(hào)：2185509
本文鏈接：http://sikaile.net/yixuelunwen/fuchankeerkelunwen/2185509.html
最近更新
教材專著
