Kamali P, Hohmann M, Herrero J, Künzel W
Universitäts-Frauenklinik Giessen.
Zentralbl Gynakol. 1998;120(6):293-300.
In a randomized, prospective study at the Dept. of Obstetrics and Gynecology of the University Hospital of Giessen 4 different ways of inducing abortions with prostaglandins were tested between the 15th and 24th week of gestation. The aim of the study was to determine the best approach to inducing abortion in order to minimize the psychological and physical stress to the patient. Subjects randomized to the first two groups got a single cervical installation of either 0.5 mg Dinoprostongel (Prepidil, N = 22) or 0.5 mg Sulprostongel (Nalador, N = 21). Six hours later, i.v. infusion with Sulproston (8.3 micrograms/min) was started and continued until the abortion was complete. Patients randomized to the third and fourth group received either 0.5 mg Dinoprostongel intracervically (N = 15) or 1 mg Gemeprost vaginal suppositories (Cergem, N = 21) every 6 hours until the cervix was 1-2 cm dilated. Subsequently the patients received an i.v. infusion with Sulproston until the abortion was complete. In the first group with intracervical application of Sulproston the total time until abortion was 17.8 h +/- 7.8 h. This was shorter than following a single application of Dinoprostongel (22.5 h +/- 14.7 h). Although there was a five hours difference, the between-group differences were not statistically different because of a wide range in values following Dinoproston treatment. This range could not be explained by the age of the mother, week of gestation or parity. In the group receiving multiple intracervical applications of Dinoproston the time till expulsion was twice as long as that after multiple vaginal suppositories of Gemeprost (33.8 h +/- 13.9 h vs. 15.6 +/- 6.0 h, p < 0.01). The time span until a cervical dilatation of 1-2 cm was 27.0 h +/- 13.7 h in the group with repeated Dinoproston application. This period of time was more than twice the time span seen in the group with repeated Gemeprost application (12.5 h +/- 4.2 h, p < 0.01). On the average four treatments with intracervical Dinoprostongel were required while the average with Gemeprost vaginal suppositories was two to achieve a cervical dilatation of 1-2 cm. Furthermore in 7 of 21 cases treatment with Gemeprost achieved the expulsion of the fetus without Sulproston infusion (11.4 h +/- 5.2 h). Comparing single versus repetitive prostaglandin application we could demonstrate that the duration of Sulproston infusion was cut in half after repeated therapy with Gemeprost. We conclude that repetitive application of Gemeprost vaginal suppositories decreases the time to abortion and subject discomfort tremendously. The application of Gemeprost suppositories provides the easiest and most efficient therapeutic approach for both patients and staff. Furthermore the regiment that provided the best results was also the most cost-effective (range 180,-DM to 317,- DM per case).
在吉森大学医院妇产科进行的一项随机前瞻性研究中，对妊娠第15至24周期间使用前列腺素引产的4种不同方法进行了测试。该研究的目的是确定引产的最佳方法，以尽量减少对患者的心理和身体压力。随机分为前两组的受试者宫颈单次放置0.5毫克地诺前列酮凝胶（普贝生，N = 22）或0.5毫克硫前列酮凝胶（纳拉多，N = 21）。6小时后，开始静脉输注硫前列酮（8.3微克/分钟）并持续至流产完成。随机分为第三组和第四组的患者每6小时宫颈内给予0.5毫克地诺前列酮凝胶（N = 15）或1毫克吉美前列素阴道栓剂（塞杰姆，N = 21），直至宫颈扩张1 - 2厘米。随后患者接受静脉输注硫前列酮直至流产完成。在宫颈内应用硫前列酮的第一组中，直至流产的总时间为17.8小时±7.8小时。这比单次应用地诺前列酮凝胶后的时间（22.5小时±14.7小时）短。尽管有5小时的差异，但由于地诺前列酮治疗后值的范围较宽，组间差异无统计学意义。这个范围无法用母亲的年龄、妊娠周数或产次来解释。在接受多次宫颈内应用地诺前列酮的组中，直至排出的时间是多次阴道应用吉美前列素栓剂后时间（33.8小时±13.9小时对15.6±6.0小时，p < 0.01）的两倍。在重复应用地诺前列酮的组中，直至宫颈扩张1 - 2厘米的时间跨度为27.0小时±13.7小时。这段时间是重复应用吉美前列素的组中时间跨度（12.5小时±4.2小时，p < 0.01）的两倍多。宫颈内应用地诺前列酮凝胶平均需要4次治疗，而阴道应用吉美前列素栓剂平均需要2次治疗才能使宫颈扩张1 - 2厘米。此外，在21例中有7例使用吉美前列素治疗无需输注硫前列酮即可排出胎儿（11.4小时±5.2小时）。比较单次与重复应用前列腺素，我们可以证明在重复使用吉美前列素治疗后，硫前列酮输注时间缩短了一半。我们得出结论，重复应用吉美前列素阴道栓剂可显著缩短流产时间并减轻患者不适。吉美前列素栓剂的应用为患者和医护人员提供了最简单、最有效的治疗方法。此外，效果最佳的方案也是最具成本效益的（每例范围为180 - 317德国马克）。
