宫腔操作前米索前列醇不同给药途径对宫颈成熟影响的Meta分析

摘要

Objective:To assess the efficacy and side effects of different routes of misoprostol administration for cervical ripening before uterine cavity operation. Methods:The databases of Medline,Embase,the Cochrane Library,CNKI,CBM, Wanfang Data were retrieved to October 2014. According to the inclusion and exclusion criteria ,literature was screened and extracted by two researchers independently ,and then the quality was reviewed by and treated by using Rev Man 5.2 software. Results:12 studies with 2 529 participants were included. Evidence was found that there were no statistical differences in cervical diameter,when misoprostol administered orally or sublingually or vaginally were compared in pairs (P>0.05). Uterine cavity operation time in vaginally administered was less than in the orally (P<0.05), but there was no significant difference in cervical dilatation time (P>0.05). And the above two index in sublingually administerd were less than in vaginally (P<0.05). The incidence of nausea and diarrhea were found to be more common in the orally and sublingually administered misoprostol group compared with vaginally administered,and emesis was found to be more common in sublingually administered misoprostol group when comparing with vaginally administered misoprostol group(P<0.05). In addition,different routes of misoprostol administration were no statistical differences in incidence of side effects including cramping,vaginal bleeding,fever and shivering (P>0.05). Conclusions:Misoprostol administered orally or sublingually had similar efficacy in cervical ripening of vaginal misoprostol. In view of avoiding drug related side effects,vaginally route of misoprostol could be considered as an effective medication.%目的:评价宫腔操作前米索前列醇通过不同给药途径促宫颈成熟的作用效果及不良反应. 方法:计算机检索Medline、Embase、The Cochrane Library、中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据库,时限为自建库至2014年10月. 由2名研究者按照纳入标准与排除标准独立筛选文献、 提取资料和评价文献质量后, 采用RevMan5.2软件进行Meta分析.结果:共纳入12篇文献,共2 529例患者.Meta分析结果显示,口服、舌下含服和阴道给药3种给药方式两两比较均提示其宫颈宽度的差异无统计学意义(均P>0.05);阴道给药后宫腔操作用时少于口服给药(P<0.05),但扩张宫颈耗时差异无统计学意义(P>0.05);舌下含服后扩张宫颈耗时和宫腔操作用时均少于阴道给药(均P<0.05).在药物相关不良反应方面,口服及舌下含服米索前列醇后腹泻与恶心发生率明显高于阴道给药(均P<0.05),舌下给药后呕吐发生率明显高于阴道给药(P<0.000 1);此外,各种给药途径子宫痉挛收缩、阴道出血、发热、寒颤等不良反应的发生率比较差异无统计学意义(P>0.05).结论:口服、舌下含服和阴道给药3种给药途径在促宫颈成熟方面无差异;考虑避免药物相关不良反应,建议在宫腔操作前采取阴道给予米索前列醇.