阴道应用米索前列醇对非妊娠妇女的宫颈作用  

Vaginal misoprostol application for cervical priming in nonpregnant women

作　　者：陈琦[1] 张健[1] 沈晓华[1] 沈慧颖[1] 

机构地区：[1]上海交通大学附属国际和平妇幼保健院妇科,200030

出　　处：《上海医学》2008年第1期21-23,共3页Shanghai Medical Journal

摘　　要：目的评价米索前列醇应用于妇科官腔镜检查术前宫颈预准备的效果。方法将199例行宫腔镜检查的患者随机分为两组,米索前列醇(米索)组(101例)检查前12h阴道内置米索前列醇400μg,对照组(98例)检查前12h阴道内置甲硝唑400mg。记录用药后不良反应、扩张宫颈并发症、手术前宫颈内口宽度、需要进一步扩张宫颈病例数、宫颈软化程度,采用疼痛视觉模拟评分法(VAS评分)评估疼痛程度。结果米索组的不良反应发生率为13.9%,显著高于对照组的4.1%(P<0.01),但均为轻微的不良反应。米索组的扩张宫颈并发症发生率为4.0%,显著低于对照组的13.3%(P<0.01)。米索组的术前宫颈内口宽度为(6.2±3.3)cm,显著长于对照组的(5.0±2.6)cm(P<0.05)。米索组的宫颈软化显效率为23.8%,显著高于对照组的11.2%(P<0.05);术中仍需扩张宫口的发生率为53.5%,显著低于对照组的68.4%(P<0.05)。米索组的镇痛效果及愿意接受率均明显优于对照组(P值均<0.01)。米索组在绝经前、后的术前宫颈内口宽度均显著大于对照组(P值均<0.01)。结论官腔镜检查术前12h阴道置米索前列醇400μg,是方便、有效的软化宫颈的方法,可缓解有创检查和减轻疼痛,减少手术操作,对绝经后妇女同样有效,值得临床推广应用。Objective To evaluate the efficacy of vaginal misoprostol for cervical priming prior to operative hysteroscopy for gynecological examination in nonpregnant women. Methods A total of 199 nonpregnant women scheduled for hysteroscopy were randomly assigned to misoprostol group（n= 101） and metronidazole group（n= 98）. Twelve hours before the procedure, the women in misoprostol group received intravaginal misoprostol （400μg） and those in metronidazole group had intravaginal metronidazole（400 mg） for cervical priming. The adverse effects of both drugs, complications during cervical dilation, cervical width before operation, number of women who required intraoperative cervical dilation, and the degree of cervical softening were recorded, and the pain during cervical dilation was evaluated using visual analogue scale（VAS）. Results Compared with metro nidazole, intravaginal misoprostol application was associated with an significantly higher incidence of adverse effects （4.1% vs 13.9%, P 〈 0.01）, but all of which were mild and well tolerated. The incidence of complications during cervical dilation were significantly lower in misoprostol group than in metronidazole group（4.0% vs 13.3%, P 〈 0.01）, and the former group had significantly greater preoperative cervical width [（6.2 ± 3.3） cm vs （5.0 ±2.6） cm, P 〈 0. 05）], fewer cases requiring intraoperative cervical dilation, and better cervical softening. The analgesic effect and tolerability of misoprostol were obvious better than those of metronidazole. Application of misoprostol in postmenopausal women produced similar effects. Conclusions Vaginal misoprostol（400 mg） applied 12h before hysteroscopy is ideal for effective and convenient cervical softening in nonpregnant women, which may ease the cervical resistance and pain and reduce the need for intraoperative cervical dilation; it is also well applicable in postmenopausal women.

关 键 词：米索前列醇 宫腔镜检查 宫颈 随机双盲 

分 类 号：R711[医药卫生—妇产科学]