美服培酮併用口服前列腺素對於早期懷孕之藥物流產的療效

RU486 Combined with Oral Misoprostol for Medical Abortion in First-Trimester Pregnant Women

陳國嶸(Kuo-Jung Chen) ； 林隆堯(Long-Yau Lin)

《中山醫學雜誌》 14卷1期 (2003/01) Pp. 63-70

https://doi.org/10.30096/CSMJ.200301.0008

摘要

研究目的：過去對於早期懷孕的孕婦，若想要終止妊娠，絕大多數都是採用子宮內膜搔刮術（D&C），但是自從RU486（Mifepristone）（美服培酮）在西元2000年12月28日於台灣合法上市以來，提供了這類孕婦另一種選擇。本實驗是將各種不同條件之早期懷孕的孕婦，想要藉由藥物來人工終止懷孕的孕婦，給予口服美服培酮及前列腺素Cytotec（Misoprostol），期望能將其結果做為日後臨床應用的基準。
材料與方法：本研究於西元2001年7月1日至2002年4月30日間，收集中山醫學大學附設醫院婦產部，兩個院區門診單位的就診孕婦，由病史、妊娠週數、經腹部或陰道超音波檢查有子宮內妊娠囊，確定診斷為早期子宮內懷孕，並且要求使用藥物人工流產的孕婦，在符合美服培酮的使用標準之下，解釋過藥物人工流產及手術人工流產的差異，並簽署藥物人工流產同意書之後，才收入此研究之中。於門診醫護人員面前，先服下3顆美服培酮共600毫克，然後在36到48小時之後回診，再服下3顆前列腺素共600微克。患者應在2週內回門診追蹤超音波，以超音波檢查未再發現有子宮內妊娠，視為藥物人工流產成功，若未成功，則以子宮內膜搔刮術來處理。
結果：研究期間總計收入了156個孕婦，她們的平均年齡是29.60 ± 6.69 歲。然而有12個孕婦接受子宮內膜搔刮術，其中有2個孕婦是因為仍有子宮內妊娠囊，所以藥物人工流產成功率為98.72%（154/ 156），完全未接受外科手術流產處理的為92.31%（144/156）。將這12個接受子宮內膜搔刮術的孕婦之各項資料，以Logistic regression 來分析，發現孕婦的年齡、孕次、產次及人工流產的次數，皆無統計上的顯著意義，故應可推論這些因子並不會造成藥物流產的失敗。
結論：想藉由藥物來終止懷孕的病人，給予口服美服培酮600毫克及前列腺素600微克來做藥物人工流產，其效果是相當令人滿意的（98.72％）。

關鍵字

美服培酮,前列腺素,藥物流產,子宮內膜搔刮術,人工流產

並列摘要

Objective: Evaluation of the effectiveness of RU486 (Misipristone) combined with oral Cytotec (Misoprostol) for medical abortion in first-trimester pregnant women.
Materials and Methods: A descriptive study of the patients visited to the outpatient departments of OB / GYN, Chung Shan Medical University Hospital between 1 July 2001 and 30 April 2002. The patients were diagnosed as intrauterine pregnancy in first-trimester by their past history, last menstrual period, present illness, gestational age, transabdominal sonography or transvaginal sonographic findings. All patients were included in this study when first-trimester intrauterine pregnancy was diagnosed, then oral mifepristone 600 mg and oral misoprostol 600μg were taken. The patients followed-up within 2 weeks. Review the successful rate of medical abortion by oral mifepristone 600 mg and oral misoprostol 600μg. No intrauterine gestational sac was found by ultrasonographic finding means successful medical abortion, and complete medical abortion without surgical intervention was measured.
Results: One hundred and fifty-six patients with different age, gestational age, parity, gravidity, sonographic findings and complications. Mean age of patients is 29.60 ± 6.69 years old. Because patients asked for complete artificial abortion and unsatisfactory vaginal bleeding was persistent, 12 patients (7.69%) were received D&C procedure under the impression of incomplete abortion (6.41%) or ongoing pregnancy (1.28%). The successful rate of oral mifepristone 600 mg combined with oral misoprostol 600μg is 98.72 % , and the complete abortion rate without surgical intervention is 92.31%.
Conclusion: Oral mifepristone 600 mg combined with oral misoprostol 600μg for medical abortion is effective in first-trimester pregnant women (successful rate: 98.72%).

並列關鍵字

RU486,mifepristone,misoprostol,cytotec,complete abortion rate