本文選題：無(wú)痛人工流產(chǎn) + 米非司酮　； 參考：《山東大學(xué)》2013年碩士論文

【摘要】：目的：探討在8-10周無(wú)痛人工流產(chǎn)術(shù)前采用米非司酮與米索前列醇預(yù)處理的臨床療效及安全性。 方法：選擇2013年1月-2013年6月就診于滕州市工人醫(yī)院婦產(chǎn)科計(jì)劃外妊娠要求行人流術(shù)的8-10周早孕患者。符合納入及排除標(biāo)準(zhǔn)的100例,均為預(yù)約手術(shù),術(shù)前禁食水6-8h。將患者隨機(jī)分為兩組：研究組與對(duì)照組,每組各50例。研究組在對(duì)照組基礎(chǔ)上術(shù)前晚8時(shí)空腹口服米非司酮150mg(6片),第2日晨8時(shí)在芬太尼聯(lián)合丙泊酚靜脈麻醉下實(shí)施無(wú)痛人工流產(chǎn)術(shù),術(shù)前半小時(shí)舌下含化米索前列醇片400ug(2片)。對(duì)照組：直接采用芬太尼聯(lián)合丙泊酚實(shí)施無(wú)痛人工流產(chǎn)術(shù)。流產(chǎn)前簽署藥物、手術(shù)、麻醉知情同意書。觀察兩組鎮(zhèn)痛效果、宮頸擴(kuò)張程度、麻醉藥用量、手術(shù)時(shí)間、術(shù)時(shí)出血量、術(shù)后離床時(shí)間、及術(shù)前、術(shù)后宮腔大小、子宮收縮幅度以及術(shù)中術(shù)后并發(fā)癥發(fā)生率(人工流產(chǎn)綜合反應(yīng)、漏吸、人工不全流產(chǎn)、宮腔宮頸粘連等)、術(shù)后陰道流血時(shí)間、月經(jīng)復(fù)潮時(shí)間,對(duì)兩組手術(shù)效果及安全性進(jìn)行比較。(該方法的使用是在患者充分知情及嚴(yán)密的臨床監(jiān)控下進(jìn)行的)。 結(jié)果：研究組0級(jí)疼痛及宮頸擴(kuò)張程度明顯優(yōu)于對(duì)照組。(1)麻藥用量：研究組9.62±0.56m1,對(duì)照組13.08±1.03m1,差異有統(tǒng)計(jì)學(xué)意義,p0.05；術(shù)后離床時(shí)間：研究組7.54±0.67min,對(duì)照組12.32±1.39min,差異有統(tǒng)計(jì)學(xué)意義,p0.05;(2)術(shù)時(shí)出血量：研究組16.59±4.38m1,對(duì)照組20.39±5.77m1,差異有統(tǒng)計(jì)學(xué)意義,p0.05;手術(shù)使用時(shí)間：研究組3.42±0.26min,對(duì)照組4.38±0.43min,差異有統(tǒng)計(jì)學(xué)意義,p0.05；(3)術(shù)前、術(shù)后宮腔深度及子宮收縮幅度：研究組10.21±0.51cm、8.37±1.38cm、1.86±0.31cm,對(duì)照組10.74±0.49cm、9.59±1.38cm、1.58±0.38cm,差異有統(tǒng)計(jì)學(xué)意義,p0.05；(4)兩組患者術(shù)后陰道流血時(shí)間有統(tǒng)計(jì)學(xué)意義,p0.05；(5)研究組患者術(shù)后月經(jīng)復(fù)潮時(shí)間短于對(duì)照組差異有統(tǒng)計(jì)學(xué)意義,p0.05(6)研究組與對(duì)照組術(shù)中術(shù)后并發(fā)癥比較差異無(wú)統(tǒng)計(jì)學(xué)意義,p0.05。 結(jié)論：在8-10周無(wú)痛人工流產(chǎn)前采用米非司酮與米索前列醇預(yù)處理,具有軟化宮頸,減少麻醉藥物的用量、術(shù)中出血量,縮短手術(shù)時(shí)間,促進(jìn)子宮收縮,術(shù)后出血時(shí)間短,月經(jīng)復(fù)潮快的優(yōu)點(diǎn),可作為8-10周無(wú)痛人工流產(chǎn)前的常規(guī)預(yù)處理,值得推廣。
[Abstract]:Objective: to investigate the clinical efficacy and safety of mifepristone and misoprostol preconditioning before 8-10 weeks painless induced abortion. Methods: from January 2013 to June 2013, patients with 8 to 10 weeks of early pregnancy who were admitted to Teng Zhou Workers' Hospital for ectopic pregnancy were selected from January 2013 to June 2013. 100 patients who met the criteria of inclusion and exclusion were all scheduled for operation and fasting water for 6-8 hours before operation. Patients were randomly divided into two groups: study group and control group, 50 cases in each group. The study group took mifepristone 150mg(6 tablets on an empty stomach at 8 pm before operation on the basis of the control group, and painless artificial abortion was performed under intravenous anesthesia of fentanyl and propofol at 8 am on the 2nd morning. 400ug(2 tablets of misoprostol tablets were sublingual for half an hour before operation. Control group: fentanyl combined with propofol was used for painless induced abortion. Sign informed consent to medication, surgery and anesthesia prior to abortion. The analgesic effect, the degree of cervical dilatation, the dosage of anesthetic, the time of operation, the amount of bleeding during operation, the time of leaving the bed after operation, and the size of uterine cavity before and after operation were observed. The amplitude of uterine contraction and the incidence of intraoperative and postoperative complications (synthetic reaction of artificial abortion, leakage of aspiration, artificial incomplete abortion, uterine cavity cervix adhesions, etc.), postoperative vaginal bleeding time, menstrual resuscitation time, etc. The effect and safety of operation were compared between the two groups. The use of this method is carried out with the patient's full knowledge and close clinical monitoring. Results: the level of pain and cervical dilatation in the study group was significantly better than that in the control group (9.62 鹵0.56m-1, 13.08 鹵1.03ml, P 0.05), and the time after operation was 7.54 鹵0.67min in the study group and 12.32 鹵1.39min in the control group. The amount of bleeding in the study group was 16.59 鹵4.38m-1, the control group was 20.39 鹵5.77m1.The operative time was 3.42 鹵0.26min in the study group and 4.38 鹵0.43min in the control group. Postoperative uterine cavity depth and uterine contraction amplitude: the study group (10.21 鹵0.51cm) 8.37 鹵1.38 cm (1.86 鹵0.31 cm), the control group (10.74 鹵0.49 cm) 9.59 鹵1.38 cm (1.58 鹵0.38 cm) the difference was statistically significant (p 0.05) the time of postoperative vaginal bleeding in the study group was significantly shorter than that in the control group (P < 0.05). There was no significant difference in intraoperative and postoperative complications between the study group and the control group (P 0.05). Conclusion: the pretreatment with mifepristone and misoprostol before 8-10 weeks painless induced abortion can soften the cervix, reduce the dosage of anesthetic drugs, shorten the operation time, and shorten the bleeding time after operation. The advantage of rapid menorrhagia can be used as routine pretreatment before 8-10 weeks painless induced abortion, which is worth popularizing.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R169.42

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