Implanon皮下埋植避孕剂出血模式及副作用临床分析

姬萌霞，彭萍，刘鹏飞，刘欣燕，郁琦

(中国医学科学院 北京协和医学院 北京协和医院妇产科，北京　100730)

Implanon皮下埋植避孕剂出血模式及副作用临床分析

姬萌霞，彭萍*，刘鹏飞，刘欣燕，郁琦

(中国医学科学院 北京协和医学院 北京协和医院妇产科，北京100730)

【摘要】目的观察Implanon皮下埋植避孕剂植入后出现的出血模式改变及副作用。方法纳入有避孕需求的妇女45例，签署知情同意书后植入皮下埋植避孕剂。以90 d为一个观察期，观察避孕效果、出血模式改变和副作用。随访4个观察期。记录出血模式、痛经、体重、痤疮及其他不良反应。结果在观察期内，无意外妊娠发生。第1个观察期末，患者平均出血天数为28.2 d，平均出血次数为3.2次。频繁出血和/或出血时间延长、出血次数减少、出血次数正常、闭经者分别占40%、35.6%、35.6%和11.1%。随着使用时间的延长，在第4个观察期末，平均出血天数降至17.3 d，平均出血次数为2.3次。频繁出血和/或出血时间延长、出血次数减少、出血次数正常和闭经者分别占11.1%、41.7%、38.9%和13.9%。使用1年后，82.4%的患者痛经完全缓解或程度减轻。使用皮埋剂后患者的平均体重[(60.5±9.8)kg]显著高于放置前[(58.0±9.9)kg](P<0.01)，平均增加了(2.5±3.3)kg。其他不良反应较少，1例出现痤疮，2例出现情绪改变，1例出现嗜睡症状。结论Implanon植入1年避孕有效(有效率100%)。其最主要的副作用是出血模式的改变，但出血时间延长和/或频繁出血会随着植入时间的延长逐渐改善。Implanon能有效缓解痛经，但使用后体重有所增加，其他不良反应较少。

【关键词】避孕；皮下埋植；依托孕烯；出血模式改变；副作用

Objective： To observe the bleeding pattern change and side effects of a single-rod，subdermal，progestin-only，long-acting，and reversible contraceptive implant-Implanon.

Methods： A total of 45 healthy women were included and inserted Implanon after they signed a informed consent. The women were followed-up for four periods，90-day for one period，to observe their bleeding pattern，dysmenorrhoea，weight change，acne and other side effects.

Results： No pregnancies occurred during this study. At the end of the first 90 days，the average number of bleeding/spotting days and bleeding/spotting episodes was 28.2 days and 3.2 times respectively. Bleeding patterns were as follows：frequent and/or prolonged bleeding (40%)，infrequent (35.6%)，normal frequency (35.6%) and amenorrhoea (11.1%). However，the average number of bleeding/spotting days and bleeding/spotting episodes were decreased to 17.3 days and 2.3 times respectively at the end of the 4thperiod. The proportion of frequent and/or prolonged bleeding，infrequent，normal frequency and amenorrhoea was 11.1%，41.7%，38.9%，and 13.9% respectively. After 1 year，82.4% of patients had complete remission or symptoms relief of dysmenorrheal. The women experienced significant weight gain compared with baseline [(60.5±9.8)vs.(58.0±9.9)kg] (P<0.01)，and the average increase weight was (2.5±3.3)kg. Other side effects included acne (n=1)，mood fluctuation (n=2) and drowsiness (n=1).

Conclusions： The contraceptive efficacy (100% efficiency in one year) was satisfied with Implanon. However，Implanon is associated with change of bleeding pattern，which includes amenorrhoea and infrequent，frequent and/or prolonged bleeding. The unpleasant bleeding pattern will be gradually reduced along with extension of the insertion time. Implanon is effective in relieving dysmenorrhoea，but increases weight after use. The incidences of other side effects are rather low.

Key words： Contraception；Subdermal implant；Etonogestrel；Bleeding pattern change；Side effect

(J Reprod Med 2016，25(5)：401-405)

Implanon(依托孕烯植入剂，欧加农，荷兰)是一种新型皮下埋植避孕剂，该药所含的孕激素为依托孕烯(Etonogestrel)，共68 mg，由单根乙烯-醋酸乙烯酯聚合体(EVA)构成载体材料，有效期为3年[1]。Implanon植入后每天将微量依托孕烯恒定释放至血液，保持血药浓度恒定，从而达到长效避孕作用。本研究以使用Implanon皮下埋植避孕剂的妇女为观察对象，进行为期1年的临床观察。……