经阴道彩色多普勒超声预测药物流产不全及干预效果的探讨  

Prediction and intervention of incompuete medical abortion in early stage

作　　者：彭文湃 马育局 黄燕华 韩定英 肖敏 林叙君 

机构地区：[1]深圳市福田区人口和计划生育服务中心,518048 [2]深圳市罗湖区妇幼保健院 [3]深圳市罗湖区人口和计划生育服务中心

出　　处：《中国计划生育学杂志》2013年第4期260-262,共3页Chinese Journal of Family Planning

基　　金：广东省人口和计划生育委员会(2009313)

摘　　要：目的:探讨多普勒超声早期预测药物流产不全的敏感指标及高危病例的干预措施。方法:对196例使用药物终止妊娠的健康妇女,在其孕囊排出当天使用经阴道彩色多普勒超声检测其孕囊着床部位的血流信号及螺旋动脉阻力指数(RI),进而选择早期预测药物流产不全的最佳RI值。再对358例进行药物流产的健康妇女通过预测值获取药物流产不全高危者60例随机分为两组,流产后分别加服米非司酮(米非司酮治疗组)、生化汤(生化汤治疗组)各30例,观察比较两组药物流产结局。结果:196例药物流产妇女中,完全流产者(167例)孕囊排出当天着床部位血流信号消失或螺旋动脉RI值显著增大(P<0.01),不完全流产者(29例)的RI值变化不显著(P>0.05),孕囊排出当天RI值<0.6预测药物流产不全可能的准确率为96.43%。经过对RI值<0.6的60例高危病例干预,米非司酮治疗组完全流产率(63.3%)高于生化汤治疗组(13.3%)(P<0.01)。结论:采用经阴道彩色多普勒超声可对药物流产不全进行早期预测,当RI值<0.6时,可视为高危药物流产不全,在药物流产后增服米非司酮能有效减少流产不全的发生。Objective： To investigate some sensitive indicators for prediction of incomplete medical abortion fin early stage, and discuss intervention measures of high - risk women. Methods ： The transvaginal color Doppler sonography was used to test the blood signal of the gestational sac implantation site and the resistance index （RI） value of its spiral artery in 196 health women who experienced medical abortion. Then 60 high - risk women determined with RI value were divided into two groups （30 women in each group）. Women were administered with mifepristone （mifepristone treatment group） and Shenghua Decoc- tion （ Shenghua Decoction treatment group）. The outcome of the medical abortion was assessed. Results ： For patients of com- plete abortion, the blood signal of the gestational sac implantation site disappeared or the RI value significantly increased after the gestational sac discharge （P 〈 0.01 ）. For the patients of incomplete abortion, the change of the RI value was not statisti- cally significant （P 〉 O. 05 ）. The spiral arterial RI value of the implantation site after the gestational sac discharge was less than O. 6, which suggested that it was highly possible of incomplete medical abortion, and the predicting accuracy rate was 96. 43%. After treatment, the complete abortion rate of the mifepristone treatment group （63.3%） was significantly higher than that of the Shenghua Decoction treatment group （ 13.3%, P 〈 O. O1 ）. Conclusion： The transvaginal color Doppler sonography can be used for prediction of the incomplete medical abortion in the early stage. The high - risk incomplete abortion is sugges- ted when RI is less than 0.6. And for the high - risk women, supplement with mifepristone after routine method of medical a- bortion can effectively prevent incomplete abortion.

关 键 词：药物流产 流产不全 经阴道彩色多普勒超声 预测 干预措施 

分 类 号：R445.1[医药卫生—影像医学与核医学]