王璐 郭晨 曹華斌
【摘要】 目的:探討屈螺酮炔雌醇片(Ⅱ)(商品名:優(yōu)思悅)對(duì)人工流產(chǎn)術(shù)后子宮內(nèi)膜恢復(fù)及術(shù)后并發(fā)癥的影響。方法:選取2018年4月-2019年12月在本院進(jìn)行人工流產(chǎn)手術(shù)的90例患者,按照隨機(jī)數(shù)字表法分為觀察組和對(duì)照組,每組45例。兩組人工流產(chǎn)術(shù)后當(dāng)日給予甲硝唑片,新生化顆粒服用時(shí)間為1周;觀察組在以上給藥方案基礎(chǔ)上給予屈螺酮炔雌醇片(Ⅱ),對(duì)照組給予安慰劑,服用時(shí)間均為1個(gè)月。比較兩組術(shù)后恢復(fù)情況、并發(fā)癥發(fā)生情況、治療前后子宮血流動(dòng)力學(xué)指標(biāo)。結(jié)果:觀察組陰道流血時(shí)間明顯短于對(duì)照組,陰道流血量明顯少于對(duì)照組,月經(jīng)恢復(fù)時(shí)間明顯早于對(duì)照組,術(shù)后3周子宮內(nèi)膜厚度明顯厚于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。觀察組術(shù)后并發(fā)癥發(fā)生率明顯低于對(duì)照組(P<0.05)。治療后,兩組子宮動(dòng)脈搏動(dòng)指數(shù)、阻力指數(shù)均低于治療前(P<0.05),兩組血流量、血流峰值速度均顯著高于治療前(P<0.05),觀察組子宮動(dòng)脈搏動(dòng)指數(shù)、阻力指數(shù)均顯著低于對(duì)照組(P<0.05),血流量、血流峰值速度均顯著高于對(duì)照組(P<0.05)。結(jié)論:屈螺酮炔雌醇能夠通過(guò)影響子宮血流動(dòng)力學(xué)相關(guān)指標(biāo),有效促進(jìn)人工流產(chǎn)術(shù)后子宮內(nèi)膜的恢復(fù),安全性較高。
【關(guān)鍵詞】 屈螺酮炔雌醇 子宮內(nèi)膜 人工流產(chǎn)
[Abstract] Objective: To explore the effect of Drospirenone Ethinylestradiol Tabels (Ⅱ) (trade name: Yousiyue) on endometrial recovery and postoperative complications after induced abortion. Method: A total of 90 patients who underwent induced abortion in our hospital from April 2018 to December 2019 were selected, they were randomly divided into observation group and control group, 45 cases in each group. The two groups were given Metronidazole Tablets on the day after artificial abortion, and the New Biochemical Granules were taken for 1 week. Observation group based on the above dosage regimen for Drospirenone Ethinylestradiol Tabels (Ⅱ), the control group given a placebo, taking time for 1 month. Result: The duration of vaginal bleeding in the observation group was significantly shorter than that in the control group, the amount of vaginal bleeding was significantly less than that in the control group, the menstrual recovery time was significantly earlier than that in the control group, the endometrial thickness was significantly thicker 3 weeks after operation than that in the control group, the differences were statistical significance (P<0.05). The incidence of postoperative complications in the observation group was significantly lower than that in the control group (P<0.05). After treatment, two groups of uterine artery pulsation index and resistance index were lower than before treatment (P<0.05), two groups of blood flow, blood flow peak velocity were significantly higher than before treatment (P<0.05), uterine artery pulsation index and resistance index in the observation group were significantly lower than those of the control group (P<0.05), blood flow, blood flow peak velocity were significantly higher than those of the control group (P<0.05). Conclusion: Drospirenone Ethinylestradiol can effectively promote the recovery of endometrium after induced abortion by influencing uterine hemodynamic indexes, it is safe.
[Key words] Drospirenone Ethinylestradiol Endometrium Abortion
First-authors address: Jiangxi Maternal and Child Health Hospital, Nanchang 330006, China
doi:10.3969/j.issn.1674-4985.2021.11.031
人工流產(chǎn)是避孕失敗的常用補(bǔ)救措施,雖然從手術(shù)技術(shù)操作方面來(lái)講屬于微創(chuàng)手術(shù),但是對(duì)子宮內(nèi)膜也將造成一定的損傷[1]。部分進(jìn)行人工流產(chǎn)的患者由于自身免疫力低下或合并其他基礎(chǔ)疾病,術(shù)后可發(fā)生子宮內(nèi)膜功能恢復(fù)不良[2]。研究證實(shí),人工流產(chǎn)術(shù)后子宮內(nèi)膜基底層將再生,從而形成新的子宮內(nèi)膜組織。以上過(guò)程完成后,子宮內(nèi)膜恢復(fù)到合適的厚度,修復(fù)過(guò)程才得以完成。若由于某種原因?qū)е碌淖訉m內(nèi)膜修復(fù)不良,將造成月經(jīng)周期紊亂、不規(guī)則陰道出血,或繼發(fā)性不孕等[3]。因此,在人工流產(chǎn)術(shù)后常規(guī)給予抗感染治療的基礎(chǔ)上,采用相應(yīng)的措施促進(jìn)子宮內(nèi)膜的修復(fù),是有效促進(jìn)人工流產(chǎn)患者術(shù)后康復(fù)的重要治療環(huán)節(jié),現(xiàn)報(bào)道如下。
1 資料與方法
1.1 一般資料 選取2018年4月-2019年12月在本院進(jìn)行人工流產(chǎn)手術(shù)的90例患者為研究對(duì)象。納入標(biāo)準(zhǔn):35歲≥年齡≥18歲;既往身體健康;月經(jīng)周期規(guī)律;妊娠試驗(yàn)陽(yáng)性;盆腔彩超提示為宮內(nèi)孕;孕周5~12周;無(wú)人工流產(chǎn)禁忌證;無(wú)口服避孕藥禁忌證。排除標(biāo)準(zhǔn):患嚴(yán)重心、肝、腎臟器質(zhì)性病變;患惡性腫瘤;合并精神或神經(jīng)系統(tǒng)疾病不能配合治療;對(duì)本次研究中應(yīng)用的藥物嚴(yán)重過(guò)敏;合并內(nèi)分泌系統(tǒng)疾病;合并血液系統(tǒng)或自身免疫系統(tǒng)疾病。按照隨機(jī)數(shù)字表法隨機(jī)分為觀察組和對(duì)照組,每組45例。患者或家屬均書面簽署《知情同意書》,符合知情同意原則,本研究經(jīng)院倫理委員會(huì)批準(zhǔn)。
1.2 方法 兩組進(jìn)行人工流產(chǎn)術(shù)后當(dāng)日給予甲硝唑片(生產(chǎn)廠家:康美藥業(yè)股份有限公司生產(chǎn),批準(zhǔn)文號(hào):國(guó)藥準(zhǔn)字H44024120,規(guī)格:0.2 g/片),口服,2片/次,3次/d;新生化顆粒(生產(chǎn)廠家:江蘇融昱藥業(yè)有限公司,批準(zhǔn)文號(hào):國(guó)藥準(zhǔn)字Z20163013,規(guī)格:9 g/袋),口服,2袋/次,3次/d,服用時(shí)間為1周。觀察組在以上給藥方案基礎(chǔ)上給予屈螺酮炔雌醇片(Ⅱ)(商品名:優(yōu)思悅,生產(chǎn)廠家:德國(guó)拜耳醫(yī)藥保健有限公司生產(chǎn),批準(zhǔn)文號(hào):國(guó)藥準(zhǔn)字J20080085,規(guī)格:屈螺酮3 mg/片,炔雌醇0.02 mg/片),口服,1片/d,服用時(shí)間1個(gè)月。對(duì)照組給予安慰劑,服用時(shí)間1個(gè)月。
1.3 觀察指標(biāo) (1)比較兩組術(shù)后恢復(fù)情況,術(shù)后陰道流血時(shí)間、陰道流血量、月經(jīng)恢復(fù)時(shí)間、術(shù)后3周時(shí)經(jīng)彩色多普勒檢查子宮內(nèi)膜厚度。(2)比較兩組術(shù)后3個(gè)月內(nèi)的并發(fā)癥發(fā)生情況,包括宮腔粘連、宮腔積液、月經(jīng)失調(diào)和盆腔炎。(3)比較兩組子宮血流動(dòng)力學(xué)指標(biāo),分別于治療前、治療3個(gè)月后,采用超聲診斷儀檢測(cè)子宮動(dòng)脈搏動(dòng)指數(shù)、阻力指數(shù)、血流量、血流峰值速度。
1.4 統(tǒng)計(jì)學(xué)處理 采用SPSS 25.0軟件對(duì)所得數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析,計(jì)量資料以(x±s)表示,組間比較采用獨(dú)立樣本t檢驗(yàn),組內(nèi)比較采用配對(duì)t檢驗(yàn);計(jì)數(shù)資料以率(%)表示,比較采用字2檢驗(yàn)。以P<0.05為差異有統(tǒng)計(jì)學(xué)意義。
2 結(jié)果
2.1 兩組基線資料比較 兩組年齡、停經(jīng)時(shí)間、孕次、流產(chǎn)次數(shù)比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05),具有可比性,見(jiàn)表1。
2.2 兩組術(shù)后恢復(fù)情況比較 觀察組陰道流血時(shí)間明顯短于對(duì)照組,陰道流血量明顯少于對(duì)照組,月經(jīng)恢復(fù)時(shí)間明顯早于對(duì)照組,術(shù)后3周子宮內(nèi)膜厚度明顯厚于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。見(jiàn)表2。
2.3 兩組術(shù)后并發(fā)癥發(fā)生情況比較 觀察組術(shù)后并發(fā)癥發(fā)生率明顯低于對(duì)照組(P<0.05),見(jiàn)表3。
2.4 兩組治療前后子宮血流動(dòng)力學(xué)指標(biāo)比較 治療前,兩組子宮動(dòng)脈搏動(dòng)指數(shù)、阻力指數(shù)、血流量、血流峰值速度比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。治療后,兩組子宮動(dòng)脈搏動(dòng)指數(shù)、阻力指數(shù)均低于治療前(P<0.05),兩組血流量、血流峰值速度均顯著高于治療前(P<0.05),觀察組子宮動(dòng)脈搏動(dòng)指數(shù)、阻力指數(shù)均顯著低于對(duì)照組,血流量、血流峰值速度均顯著高于對(duì)照組(P<0.05)。見(jiàn)表4。
3 討論
研究發(fā)現(xiàn),人工流產(chǎn)術(shù)后口服雌激素及避孕藥物對(duì)于術(shù)后患者子宮內(nèi)膜的修復(fù)具有明顯的促進(jìn)作用[4]。屈螺酮炔雌醇片(Ⅱ)是最新研制的避孕藥物,是由屈螺酮與炔雌醇組成的復(fù)方制劑。屈螺酮又稱為二氫螺利酮,是一種新型合成孕激素,具有抗鹽皮質(zhì)激素活性,能夠防止體液潴留引起的體重增加,而且沒(méi)有任何雄激素、雌激素、糖皮質(zhì)激素的活性,因此屈螺酮的生化特性與藥理學(xué)特性均與天然孕激素十分相似[5]。炔雌醇是人工合成的高效雌激素,其在人體內(nèi)能對(duì)下丘腦和垂體發(fā)揮正反饋、負(fù)反饋的作用,大劑量應(yīng)用的情況下,可有效抑制促性腺激素的分泌,從而抑制卵巢排卵[6]。研究數(shù)據(jù)表明,屈螺酮炔雌醇片(Ⅱ)能夠調(diào)節(jié)機(jī)體分泌功能,促進(jìn)子宮內(nèi)膜修復(fù)[7]。宋志秀等[8]在研究中分析了屈螺酮炔雌醇片對(duì)稽留流產(chǎn)清宮術(shù)后患者激素水平及宮腔粘連的影響。本研究結(jié)果顯示,患者術(shù)后在抗生素抗感染的基礎(chǔ)上口服屈螺酮炔雌醇片,術(shù)后子宮內(nèi)膜厚度顯著高于對(duì)照組,證實(shí)了屈螺酮炔雌醇片在稽留流產(chǎn)清宮術(shù)后具有促進(jìn)子宮內(nèi)膜修復(fù)方面的作用。本研究結(jié)果也顯示,在人工流產(chǎn)患者術(shù)后的治療過(guò)程中,在常規(guī)抗感染的基礎(chǔ)上應(yīng)用屈螺酮炔雌醇片,顯著縮短了患者術(shù)后的陰道流血時(shí)間和月經(jīng)恢復(fù)時(shí)間(P<0.05),減少了陰道流血量(P<0.05),且應(yīng)用屈螺酮炔雌醇片進(jìn)行治療的觀察組患者術(shù)后3個(gè)月內(nèi)的并發(fā)癥發(fā)生率顯著低于對(duì)照組(P<0.05)。這與文獻(xiàn)[9-10]的研究基本一致,均證實(shí)了屈螺酮炔雌醇片在改善人工流產(chǎn)術(shù)后臨床癥狀和降低并發(fā)癥發(fā)生率方面的優(yōu)勢(shì)。
影響人工流產(chǎn)術(shù)后的子宮內(nèi)膜恢復(fù)情況的因素不僅包括適宜的子宮內(nèi)膜厚度,還包括子宮的血流情況[11]。手術(shù)操作本身對(duì)子宮內(nèi)膜造成損傷的同時(shí),也可能傷及內(nèi)膜的基底層或血管,將導(dǎo)致子宮內(nèi)膜的基底層的供血不充足,這也是引起月經(jīng)不規(guī)律、出血量增加的重要原因[12]。子宮螺旋動(dòng)脈是營(yíng)養(yǎng)子宮內(nèi)膜的主要血供血管,若由于手術(shù)等操作傷及該動(dòng)脈,將造成血運(yùn)異常,影響子宮內(nèi)膜良好的容受性的同時(shí),也可以引起基底層血供不良,延緩子宮內(nèi)膜修復(fù)的速度[13]。子宮動(dòng)脈搏動(dòng)指數(shù)、阻力指數(shù)是反映卵巢間質(zhì)的灌注情況的重要參考指標(biāo),測(cè)量值越低,表明受檢者的卵巢間質(zhì)的血流量越豐富[14]。血流量和血流峰值速度是反映子宮內(nèi)膜血管發(fā)生和血管形成以及血流情況的重要參考指標(biāo),血流量越高,血流峰值速度越高,說(shuō)明子宮內(nèi)膜組織中的毛細(xì)血管越豐富,組織修復(fù)所能夠獲得的營(yíng)養(yǎng)越充足[15-17]。本研究結(jié)果顯示,應(yīng)用屈螺酮炔雌醇的觀察組患者經(jīng)超聲診斷儀檢測(cè)得到的子宮動(dòng)脈搏動(dòng)指數(shù)、阻力指數(shù)均顯著低于對(duì)照組(P<0.05),血流量、血流峰值速度均顯著高于對(duì)照組(P<0.05),提示屈螺酮炔雌醇能夠通過(guò)降低動(dòng)脈血流阻力改善微循環(huán)狀態(tài),對(duì)促進(jìn)子宮內(nèi)膜的修復(fù)發(fā)揮積極的作用[18-20]。
綜上所述,屈螺酮炔雌醇能夠通過(guò)影響子宮血流動(dòng)力學(xué)相關(guān)指標(biāo),有效促進(jìn)人工流產(chǎn)術(shù)后子宮內(nèi)膜的恢復(fù),減少并發(fā)癥的發(fā)生,安全性高。
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(收稿日期:2020-07-22) (本文編輯:劉蓉艷)