施晓等

[摘要] 目的 探讨透明质酸钠凝胶对人工流产术后宫腔粘连的预防价值，以期为透明质酸钠凝胶的临床应用提供参考。 方法 选择2013年8月～2014年8月于浙江省舟山市妇幼保健院行人工流产术患者110例，根据流产术后不同治疗方法分为观察组与对照组，每组各55例。对照组术后给予口服益母草胶囊等抗生素进行常规预防治疗。观察组术后注射医用透明质酸钠凝胶2～3 mL。观察两组患者术后宫腔粘连发生情况、月经情况（腹痛时间、月经复潮时间、术后阴道出血时间及出血量）、微循环情况（毛细血管流速、白色微血栓数、红细胞聚集指数）及并发症发生情况。 结果 观察组术后宫腔粘连程度较对照组明显降低，两组比较差异有统计学意义（P < 0.05）。观察组腹痛时间、月经复潮时间、术后阴道出血时间均短于对照组，术后阴道出血量少于对照组，差异均有统计学意义（均P < 0.05）。两组各微循环指标结果显示，观察组毛细血管流速及红细胞聚集指数高于对照组，白色微血栓数少于对照组，两组差异有统计学意义（P < 0.05）。观察组术后感染率低于对照组，差异有统计学意义（P < 0.05）。 结论 透明质酸钠凝胶具有止血、预防感染及粘连的作用，其采用宫腔注入的方式，操作简单，效果明显，并发症少，为透明质酸钠凝胶的临床应用提供参考。

[关键词] 透明质酸钠凝胶；宫腔粘连；人工流产术

[中图分类号] R714.21 [文献标识码] A [文章编号] 1673-7210（2015）02（b）-0044-04

[Abstract] Objective To discuss the prevention value of sodium hyaluronate gel for intrauterine adhesion after artificial abortion operation， in order to provide references for clinical application of sodium hyaluronate gel. Methods 110 cases underwent artificial abortion operation from August 2013 to August 2014 in Maternal and Child Care Service Centre of Zhoushan City were selected. According to different treatments after artificial abortion operation， patients were divided into the observation group and control group， each group had 55 cases. Patients in the control group were given antibiotics such as Motherwort capsule and so on orally. Patients in the observation group were given injection of medical sodium hyaluronate gel 2-3 mL after artificial abortion operation. The incidence of intrauterine adhesion after artificial abortion operation， menstruation situation （time of abdominal pain， menstruation recovery， vaginal bleeding and amount of bleeding after operation）， microcirculation situation （capillary flow， number of white micro thrombus， red cell assembling index） and complications between the two groups were compared. Results The intrauterine adhesion degree after artificial abortion operation in the observation group was lower than that in the control group， with statistically significant difference （P < 0.05）. The time of abdominal pain， menstruation recovery， vaginal bleeding after operation in the observation group were shorter than those in the control group， the amount of bleeding after operation in the observation was less than that in the control group， with statistically significant differences （all P < 0.05）. The microcirculation indexes were compared between the two groups， the capillary flow and red cell assembling index in the observation group were higher than those in the control group， the number of white micro thrombus in the observation group was less than that in the control group， with statistically significant differences （P < 0.05）. The incidence of infection in the observation group was lower than that in the control group， with statistically significant differences （P < 0.05）. Conclusion Sodium hyaluronate gel has effects on hemostasis， prevention of infection and adhesion. With the method of uterine cavity injection， the operation is simple， has obvious effect， fewer complications， which can provide references for clinical prevention for intrauterine adhesion after artificial abortion operation.

[Key words] Sodium hyaluronate gel； Intrauterine adhesion； Artificial abortion operation

随着社会的进步，性观念越来越开放，近年来，人工流产率逐步上升[1-3]。虽然随着技术的进步，人工流产术已经较为成熟，但仍具有一定风险。其中，宫腔粘连作为人工流产术后较严重的并发症，已经引起越来越多研究者的重视[4-5]，对于其的预防逐渐成为临床研究的热点。宫腔粘连一般是指患者子宫腔、子宫颈包括峡部的粘连，发生原因可能为感染或子宫内膜损伤等[6]。目前，已有部分研究探讨了对宫腔粘连预防[7-9]，本研究选择浙江省舟山市妇幼保健院人工流产术后患者，给予透明质酸钠凝胶，观察其对宫腔粘连的预防作用，取得了较满意的效果，以期为宫腔粘连的预防提供临床线索。……