摘要
目的评价进口米索前列醇(喜克馈)用于孕早、中期计划生育手术前扩张宫颈的临床有效性和安全性。方法计算机检索MEDLINE(1974～2005)、EMBASE(1974～2005)、Cochrane图书馆2003年3期、中国生物医学文献数据库(1979～2005)、中国学术期刊网专题全文数据库(1994～2005)、中国生物医学期刊文献数据库(1994～2005)和中文科技期刊全文数据库(1989～2005);手工检索《中华妇产科杂志》等12种杂志,收集国内外有关进口米索前列醇和吉美前列腺素用于妊娠早、中期计划生育手术前扩张宫颈作用的随机对照试验(RCT)和半随机对照试验(CCT)。采用RevMan4.2软件进行Meta分析。结果共纳入7篇人工流产术前用进口米索前列醇扩张宫颈的RCT/CCT(孕早期3篇,孕中期4篇)。结果显示,早期妊娠人工流产术前使用进口米索前列醇扩张宫颈与吉美前列腺素比较,进口米索前列醇宫颈扩张率高于吉美前列腺素[OR4.79,(95%CI1.35～16.94)];宫颈扩张度也更好;对术中出血的影响二者相似[WMD14.40,(95%CI30.30～1.30)];妊娠物排除时间也相似[WMD3.50,(95%CI9.78～2.78)];手术时间少于吉美前列腺素[WMD1.50,(95%CI3.00～0.00)];阴道出血量大于月经量发生率两组相似;进口米索前列醇和吉美前列腺素在完全流产率、胃肠道副作用发生率方面结果不一致。孕中期人工流产术前使用进口米索前列醇扩张宫颈妊娠物排除时间、引产成功率和吉美前列腺素相比结果不一致;单用进口米索前列醇的胃肠道副作用少于单用吉美前列腺素,但当二者都合用米非司酮时,二者的胃肠道副作用发生率的差异无统计学意义。结论与吉美前列腺素比较,孕早期人工流产术前使用进口米索前列醇的宫颈扩张率和宫颈扩张度等更优;孕中期人工流产术前使用进口米索前列醇经宫颈内给药,可有效提高完全流产率和缩短妊娠物排除时间。由于纳入分析的研究样本量�
Objective To evaluate the effectiveness and safety of misoprostol versus gemeprost for the first and second-trimester induction of abortion. Methods We searched randomized controlled trials（RCTs） and quasi-randomized controlled trials of misoprostol versus gemeprost for the first and second-trimester induction of abortion operation. MEDLINE （ 1974 - 2003 ）, EMBASE （ 1974 - 2003 ）, The Cochrane Library （ Issue 3, 2003 ）, CBM （ 1979 - 2003 ）, CNKI （ 1989 - 2003 ）, CMCC （ 1994 - 2003 ）, VIP （ 1989 - 2003 ） were searched. Twelve journals and reference lists of eligible studies were handsearched. Two reviewers independently screened the studies for eligibility, evaluated the quality, and extracted data from eligible studies with confirmation by cross checking. Any disputes were decided by a third person. Meta-analysis was conducted using RevMan 4.2 software. Results Seven RCTs were included, three for the first-trimester and four for the second- trimester. Statictical differences were tested between the misoprostol and gemeprost groups with OR 4. 79,95% CI 1.35 to 16.94 in laxation and dilation rate,with WMD -1.50,95% CI -3.00 to 0.00 in operation time for the first-trimester abortion. However, there was no statistical difference in the amount of bleeding during operation with WMD - 14. 40, 95% CI 30.30 to 1.30. For the second-trimester abortion, compared with gemeprost, no consistent results of gravid excluding time were obtained. Compared with gemeprost, the rate of complete abortion was higher and digest system morbidity was lower in misoprostol alone group. But there was no statistical difference between the two groups when they were both combined with mifestone. Conclusions Some evidence indicates that compared with gemeprost, misoprostol may increase laxation and dilation rate of the cervix, shorten gravid exclusion time, improve the rate of complete abortion and make the laxation and dilation range of the cerix larger than gemeprost before the first and second-trimester abortive
出处
《中国循证医学杂志》
CSCD
2005年第12期921-928,共8页
Chinese Journal of Evidence-based Medicine
