甲氨蝶呤两种给药方式联合清宫术治疗剖宫产瘢痕妊娠的疗效比较

发布时间：2018-03-26 03:02

本文选题：甲氨蝶呤　切入点：静脉滴注　出处：《中国药房》2017年24期

【摘要】：目的:比较甲氨蝶呤静脉滴注给药与子宫动脉灌注栓塞给药联合清宫术治疗剖宫产瘢痕妊娠的临床疗效和安全性。方法:90例剖宫产瘢痕妊娠患者随机分为A组和B组,每组45例。A组患者在清宫术前给予甲氨蝶呤注射液50 mg/m~2,静脉滴注;B组患者在清宫术前采用Seldinger法穿刺插管,以甲氨蝶呤注射液50 mg/m~2与明胶海绵颗粒序贯注入子宫动脉内,复查影像学确定栓塞满意后拔除置管。两组患者均每24 h复查血人绒毛膜促性腺激素(β-HCG)水平,待血β-HCG水平降至1 000 mU/mL以下后行清宫术。比较两组患者术中出血量,术后出血量,血β-HCG恢复正常时间,月经恢复正常时间,住院时间,治疗前后瘢痕妊娠病灶直径、血β-HCG水平、并发症发生情况和不良反应发生情况。结果:B组患者术中出血量、术后出血量均显著低于A组,血β-HCG恢复正常时间、月经恢复正常时间和住院时间显著短于A组,总并发症发生率显著低于A组,差异均有统计学意义(P0.05)。用药前,两组患者瘢痕妊娠病灶直径比较,差异无统计学意义(P0.05);清宫术前,两组患者瘢痕妊娠病灶直径显著小于同组用药前,且B组显著小于A组,差异均有统计学意义(P0.05)。用药前,两组患者血β-HCG水平比较,差异无统计学意义(P0.05);清宫术前后,两组患者血β-HCG水平显著低于同组用药前,且B组显著低于A组,差异均有统计学意义(P0.05)。两组患者不良反应发生率比较,差异无统计学意义(P0.05)。结论:相较于静脉滴注给药,甲氨蝶呤子宫动脉灌注栓塞给药联合清宫术治疗剖宫产瘢痕妊娠可有效减少患者围术期出血量,促进血β-HCG水平降低和月经恢复,并有助于降低相关并发症发生风险,安全性较好。
[Abstract]:Objective: to compare the clinical efficacy and safety of intravenous infusion of methotrexate and uterine artery infusion embolization in the treatment of cesarean scar pregnancy. Methods: 90 cases of cesarean scar pregnancy were randomly divided into two groups: group A (group A) and group B (group B). 45 patients in group A were given methotrexate injection 50 mg / m ~ (-2) before Qing Gong. Patients in group B were intubated by Seldinger method before Qing Gong, and 50 mg/m~2 of methotrexate injection and gelatin sponge particles were injected into uterine artery sequentially. The patients in the two groups were examined every 24 hours for the serum levels of human chorionic gonadotropin (尾 -HCG), and the patients were treated with uterine clearance after the serum 尾 -HCG level decreased to less than 1 000 mU/mL. The amount of intraoperative and postoperative bleeding was compared between the two groups. Blood 尾 -HCG returned to normal time, menstruation resumed normal time, hospitalization time, diameter of scar pregnancy focus, blood 尾 -HCG level, complications and adverse reactions before and after treatment. The amount of postoperative bleeding was significantly lower than that of group A, the blood 尾 -HCG returned to normal time, menstrual recovery time and hospitalization time were significantly shorter than group A, and the incidence of total complications in group A was significantly lower than that in group A (P 0.05). There was no significant difference in the diameter of scar pregnancy focus between the two groups (P 0.05). Before Qing Gong, the diameter of scar pregnancy focus in the two groups was significantly smaller than that in the same group and group B was significantly smaller than that in group A (P 0.05). There was no significant difference in serum 尾 -HCG levels between the two groups (P 0.05), and the serum 尾 -HCG levels of the two groups were significantly lower than those of the same group before and after the operation, and the levels in group B were significantly lower than those in group A, and the level of 尾 -HCG in group B was significantly lower than that in group A. There was no significant difference in the incidence of adverse reactions between the two groups. Conclusion: compared with intravenous drip, there is no significant difference in the incidence of adverse reactions between the two groups. Intrauterine arterial infusion of methotrexate combined with uterine curettage in the treatment of cesarean scar pregnancy can effectively reduce the perioperative bleeding, promote the decrease of blood 尾 -HCG level and menstrual recovery, and help reduce the risk of related complications. The safety is good.
【作者单位】：三亚市妇幼保健院妇产科;三亚市人民医院妇产科;
【分类号】：R714.22

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