地诺前列酮在足月孕妇引产中的临床对比观察

[摘要] 目的:评价普贝生(地诺前列酮)对足月孕妇引产的效果和安全性。方法:采用普贝生与缩宫素临床对比,普贝生治疗90例,缩宫素治疗60例,观察其对150例足月宫颈低评分孕妇促宫颈成熟的有效性和对产程的影响。结果:普贝生能提高宫颈Bishop评分(2.76±1.01)分,促宫颈成熟效果达88.89%,临产时间为(19.8±10.1) h,总产程(6.8±3.1) h,剖宫产率降至16.67%,与缩宫素比较,差异有明显的统计学意义。普贝生和缩宫素临床使用均无严重不良反应。结论:普贝生(地诺前列酮)是一种有效的促宫颈成熟和引产药物,使用方便,安全可靠。

[关键词] 普贝生(地诺前列酮);阴道栓剂;促宫颈成熟;引产

[中图分类号] R719.3+1[文献标识码]A [文章编号]1673-7210(2009)07(c)-077-02

The clinical comparison and observation of Dinoprostone to induce labor in term pregnancies

LUO Yuqing1, HUANG Sudan2, LI Wenjiao3

(1.Department of Gynecology and Obstetrics, Shenzhen 4th People's Hospital (Futian District Hospital), Shenzhen 518033, China; 2. Shenzhen 6th People's Hospital, Shenzhen 518052, China; 3.Changning Children and Maternal Hospital of Shanghai, Shanghai 200051, China)

[Abstract] Objective: To evaluate the efficiency and security of Propess (Dinoprostone) to induce labor in term pregnancies. Methods: We adopted the function of Oxytocin and Propess comparatively, 90 cases of Propess and 60 cases of Oxytocin were studied. Their efficiency to promote the ripeness of cervix and the influence on the birth process for the 150 cases of low cervical scale of term pregnancies. Results: Propess could raise the Bishop cervical scale by (2.76±1.01) scores, the efficiency to promote the ripeness of cervix could reach 88.89%, the parturient time was (19.8±10.1) hours, the total labor stages were (6.8±3.1) hours, the rate of cesarean operation dropped to 16.67%. The deviance with Oxytocin had obvious statistical significance. The clinical usage of Propess and Oxytocin had no serious adverse reactions. Conclusion: Propess (Dinoprostone) is an effective drug to promote the ripeness of cervix and induce labor. It is convenient, safe and reliable.

[Key words] Propess (Dinoprostone); Vaginal suppository; Promotion of the ripeness of cervix; Induce labor

地诺前列酮(普贝生)缓释栓是一种较为理想的足月妊娠引产药物。我院应用普贝生(Propess)对宫颈低评分产妇观察其促宫颈成熟(cervical ripening)的有效性及对产程(the course of labour)的影响。

1 资料与方法

1.1 一般资料

选取2007年6月～2008年6月我院产科入院待产的初产妇150例,入选条件:年龄23～35岁,孕38～42周,单胎头位、胎膜未破,宫颈评分≤6分,无阴道分娩及无前列腺素应用禁忌等,随机分为两组,研究组90例,对照组60例,两组孕妇年龄、孕周、宫颈评分及引产指征等无统计学差异。

1.2 方法

两组孕妇用药前均行阴道检查及宫颈Bishop评分。研究组采用控释前列腺素E2(普贝生)10 mg引产,在无菌条件下置入阴道后穹隆深处,留2～3 cm终止带于阴道口,用药后卧床2 h,给药12 h后取出药物,同时行阴道检查及宫颈Bishop评分,若发现宫缩过频(10 min超过3次)、胎儿窘迫、破膜临产或恶心呕吐等不良反应时,立即取出药物,对照组采用缩宫素2.5 U+5%葡萄糖注射液500 ml经微量泵滴入,开始8滴/min,按常规由慢到快调整滴速,最大滴速≤60滴/min,给药12 h行阴道检查及宫颈Bishop评分,若出现宫缩过频,破膜临产、胎儿窘迫,应立即停药。如果引产12 h仍未临产,次日再同法引产,连用3 d仍未临产则视为引产失败。

1.3 观察内容

①植入普贝生2 h后行阴道检查确认药物是否在原处,用药过程及用药12 h后对宫颈行Bishop评分;②用药后观察两组胎心变化、宫缩情况、临产开始时间及总产程,羊水情况及药物不良反应;③观察两组分娩方式,产后出血量,出生后5 min新生儿Apgar评分。

1.4 疗效评估标准

显效:用药后宫颈Bishop评分提高≥3分;有效:提高≥2分;无效:提高

1.5 统计学处理

应用SPSS 10.0软件包进行数据分析,计量资料采用t检验、计数资料采用χ2检验,P

2 结果

2.1 促宫颈成熟效果

见表1。

2.2 引产效果

见表2。

2.3 新生儿情况比较

普贝生组新生儿平均体重为(3 579±296) g,缩宫素组为(3 519±301)g,两组比较差异无统计学意义(P>0.05);两组新生儿出生后5 min Apgar评分分别为(9.9±0.5)分和(9.5±0.4)分,差异无统计学意义(P>0.05)。

2.4 不良反应

普贝生组2例宫缩过强,但无胎心变化和羊水污染,取出药物后恢复正常,1例产妇软产道裂伤,阴道分娩一活婴,母婴平安。两组均未见产妇胃肠道反应,低血压或心跳过速。

3 讨论

3.1 普贝生临床应用的效果

本研究的产妇均是妊娠晚期,宫颈Bishop评分均≤6分,用药后宫颈Bishop评分提高(2.76±1.01)分,促宫颈成熟效果达到88.89%。对Bishop评分

3.2 普贝生作用机制及特点

普贝生是一种控释前列腺素E2栓剂,每粒含地诺前列酮10 mg,放置阴道内能以0.3 mg/h的速度缓慢释放。PGE2促宫颈成熟的机制可能有3方面:①提高胶原酶、弹性蛋白酶的活性,使宫颈胶原纤维、细胞外基质逐步降解,使宫颈软化松弛,增加顺应性;②宫颈平滑肌松弛促进宫颈扩张,同时PGE2对子宫体平滑肌亦有收缩作用,使宫颈在胎先露的压迫下,产生机械性扩张(开产门);③增加子宫肌细胞间缝隙连接,并提高子宫对缩宫素的敏感性[2-4]。

3.3 普贝生的安全性

本研究90例临产妇常规用普贝生后2例宫缩过强,但无胎心变化和羊水污染,取出药物后恢复正常,1例产妇软道裂伤(大头胎儿),阴道分娩,母婴平安。两组均未见胃肠道反应,低血压和心跳过速等不良反应。

临床观察结果与文献报道一致[3,5],普贝生是一种有效的促宫颈成熟和引产药物,使用方便,安全可靠。

[参考文献]

[1]Facchinetti F, Venturini P, Verocchi G, et al, Comparison of two preparations of dinoprostone for pre-induction of labour in nulliparous women with very unfavourable cervical condition: a radomised clincal trial[J]. Eur J Obstet Gynecol Reprod Biol,2005,119:189-193.

[2]Vollebergt A, Vant Holf D, Exalto N. Prepidil (R) compared to Propess(R) for cervical ripening[J].Obstet Gynecal Reprod Bial,2002,104:116.

[3]华,李文佼.地诺前列酮在宫颈低评分引产中的临床应用[J].现代妇产科进展,2008,17(6):472-473.

[4]Wielgos M, Szymu Sik I, Kosinska-Kacyynska K, et al. The influence of dinoprostone on uterine cervix ripening and the course of labour[J].Neuro Endocrinol Lett,2007, 28:513-517.

[5]Wemer R. A Clinical evaluation of controlled-release dinoprostone for cervical ripening-a review of current evidence in hospital and outpatient-settings[J]. Perinal Med,2005,33:491-499.

(收稿日期:2008-09-22)