异位停加减联合甲氨蝶呤治疗未破损型输卵管妊娠的临床研究

发布时间：2018-06-10 05:03

本文选题：输卵管妊娠 + 异位停方　；参考：《南京中医药大学》2017年硕士论文

【摘要】：目的:运用中、西药联合的方法医治未破损型输卵管妊娠,并针对临床治疗效果加以剖析。通过观察符合条件的临床病例,将异位停方联合甲氨蝶呤(MTX)应用与单纯采用MTX对病例的影响作比较,以阐明中药联合MTX医治未破损型输卵管妊娠可以获得更佳的疗效,为药物保守性医治异位妊娠病提供客观的临床研究基础。方法:1.本课题所纳入的研究对象共60例,均选自2015年3月至2016年10月于江苏省中医院妇科收住入院的未破损型输卵管妊娠病患,中医证型应当分属气滞血瘀证。按照随机、单盲的原则,将要求施行药物保守治疗方案的病患划分成观察组、对照组,每组纳进30例,通过统计学软件处理,比较两组病患的年龄分布、停经时间、用药前血β人绒毛膜促性腺激素(β-HCG)值、附件包块直径及中医证候总积分,得知观察组和对照组之间均不存在显著性差别(P0.05),符合可比的条件。2.观察组30例病患按照1mg/kg或50mg/m2(常规用量为50～75mg),单次剂量肌注MTX。在使用MTX的当天同时给予口服中药汤剂,每日一剂,1周当作1个疗程,总共为1～2个疗程,随访3个月。对照组的30例病患则仅施以MTX肌注,方法同观察组。比较两组的临床疗效、中医证候疗效、用药后的中医证候积分、血β-HCG水平及其降低为阴性所需要的时间、B超检查附件包块消减程度以及不良反应发生率。3.统计学方法所有统计资料均采用SPSS 21.0统计学软件进行相应的数据处理分析。计量资料以" x±s"表示,接受t检验,计数资料接受X2检验,等级资料接受秩和检验,以P0.05为差别有统计学意义。结果:1.在临床疗效方面:观察组30例病患中有效29例,无效1例,总有效率达96.7%;对照组30例病患中有效24例,无效6例,总有效率达80.0%,比较两组之间的临床总有效率,表现为显著性差异(P0.05)。2.在中医证候疗效方面:按照中医证候疗效的判断界定标准,观察组30例病患中有1例痊愈,1例显效,20例有效,8例无效,总有效率达73.3%;对照组30例病患中有0例痊愈,0例显效,15例有效,15例无效,总有效率达50.0%,两组之间的中医证候疗效相比较,显现为显著性差异(P0.05)。用药后两组中医证候积分相比较,观察组为5.80±2.46,对照组为7.17±1.91,显示为显著性差异(P0.05)。3.经过统计学检验得知,用药第7天时,观察组血β-HCG降低≥15%的例数与对照组相比,存在显著性差别(P0.05)。用药第14天时,观察组血β-HCG降低≥1/3的例数与对照组相比,存在显著性差别(P0.05)。两组血β-HCG降低为阴性所用的时间相比,存在显著性差距(P0.05);但两组包块完全吸收的耗时相比,不存在显著性差距(P0.05)。4.在药物副作用方面:用药后观察组比对照组发生药物不良反应的例数少,并且程度较轻,疗程结束后,症状自行好转。结论:异位停方联合MTX治疗未破损型输卵管妊娠协同增效,使血β-HCG迅速下降而提高杀胚能力,促进附件包块的吸收以及缩减病程,提高了药物保守性医治本病的成功率。另外,观察组较对照组二次肌注MTX者少而降低了不良反应的发生率,且临证加减的中药可适当地缓解MTX引起的不良反应,是一种值得推广的药物保守性医治未破损型输卵管妊娠的方法。
[Abstract]:Objective: to treat the undamaged tubal pregnancy with the combination of Western medicine and Western medicine, and to analyze the effect of clinical treatment. By observing the clinical cases, the effect of the combination of ectopic pterin combined with methotrexate (MTX) and the simple use of MTX was compared to clarify the combination of traditional Chinese medicine and MTX in the treatment of undamaged tubal pregnancy. A better therapeutic effect can be obtained to provide an objective clinical research basis for the conservative treatment of ectopic pregnancy. Methods: 60 subjects were selected from 1. subjects, all of which were selected from March 2015 to October 2016 in the Department of Gynecology of Jiangsu Province Traditional Chinese Medicine Hospital. According to the random, single blind principle, the patients were divided into the observation group and the control group, and the control group was admitted into 30 cases. The age distribution of the two groups of patients, the time of the menopause, the value of the beta human chorionic gonadotropin (beta -HCG), the diameter of the appendage mass and the total score of TCM syndrome were compared by the statistical software. There was no significant difference between the observation group and the control group (P0.05), which accords with the comparable condition.2. observation group 30 patients according to 1mg/kg or 50mg/m2 (the conventional dosage is 50 to 75mg), and the single dose of MTX. was given oral Chinese herbal decoction on the same day with MTX, one dose per day, 1 weeks as 1 courses, and a total of 1~2 courses, followed up for a total of 1~2 courses. 3 months. 30 patients in the control group were treated with only MTX muscle injection, and the methods were compared with the observation group. The clinical efficacy of the two groups, the curative effect of TCM syndrome, the score of TCM syndrome after the medication, the level of blood beta -HCG and the time that it was reduced to negative, the degree of subtracting the appendage block and the incidence of adverse reactions in the two groups were all statistical methods. SPSS 21 statistics software was used for data processing and analysis. The measurement data were expressed as "x + s", received t test, counting data received X2 test, rank data received rank sum test, and P0.05 was statistically significant. Results: 1. in clinical efficacy: 30 cases of the observation group were effective in 29 cases, and 1 cases were invalid, the total effective rate reached 96.7% of the 30 cases in the control group, 24 cases were effective and 6 cases were invalid, the total effective rate was 80%, compared with the total effective rate between the two groups, the significant difference between the two groups was compared (P0.05).2. in the TCM syndrome effect: according to the standard of judging the curative effect of TCM syndrome, 1 cases were cured in 30 cases in the observation group, 1 cases were markedly effective, 20 cases were effective, 8 cases were ineffective, total The efficiency was 73.3%, 0 of the 30 cases in the control group were cured, 0 were markedly effective, 15 cases were effective, 15 cases were invalid, the total effective rate was 50%. The difference of TCM syndromes between two groups showed significant difference (P0.05). After the use of the TCM syndrome scores of two groups, the observation group was 5.80 + 2.46, and the control group was 7.17 + 1.91, showing significant difference (P0 .05) after seventh days of statistics,.3. showed that there was a significant difference (P0.05) in the number of blood beta -HCG in the observation group as compared with the control group (P0.05). The number of blood beta -HCG in the observation group was significantly different from that of the control group at fourteenth days (P0.05). Two groups of blood beta -HCG decreased to negative time compared with the control group. There was a significant difference (P0.05), but there was no significant difference (P0.05).4. in the side effects of the total absorption of the two groups. The number of adverse drug reactions in the observation group was less than that of the control group, and the degree was lighter after the treatment. Conclusion: the ectopic stop side combined with MTX for the treatment of the undamaged type. The synergistic effect of oval tube pregnancy makes the blood beta -HCG decrease rapidly, improve the ability to kill the embryo, promote the absorption of the appendage mass and reduce the course of disease, and improve the success rate of the drug conservatism to cure the disease. In addition, the observation group is less than the control group and reduces the incidence of adverse reactions two times in the control group, and the Chinese herbal medicine with the addition and subtraction can relieve the MTX properly. The adverse reaction is a drug conservative method to treat undamaged tubal pregnancy.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.22

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