输卵管异位妊娠保守药物治疗的对比分析

发布时间：2018-06-20 15:46

  本文选题：异位妊娠 + 药物保守治疗　； 参考：《上海交通大学》2014年硕士论文

【摘要】：目的 本文通过回顾性分析我院异位妊娠药物保守患者资料，探讨影响输卵管异位妊娠保守药物治疗疗效的主要影响因素，以及通过天花粉（TCS）及甲氨蝶呤（MTX）2种保守药物治疗对输卵管异位妊娠患者的疗效和副作用、临床使用意义等各方面分析，为临床医生把握药物治疗范围、选择药物种类等提供临床参考。 材料和方法 回顾性分析2008-2012年近5年上海交通大学医学院附属瑞金医院妇产科输卵管异位妊娠患者病史资料（共230例），并对患者进行电话随访，对所得资料进行整理。按药物治疗种类分为2种：天花粉组合MTX组，比较两药用于输卵管异位妊娠的成功率、住院时间，血β-HCG、转阴时间、用药后血β-HCG下降情况、药物副作用及日后妊娠的影响情况等；比较患者基本信息及相关背景对于药物保守治疗的影响意义。采用SPSS19.0统计软件对数据进行统计描述和分析，统计方法包括卡方检验、t检验、Logistic回归分析多因素等方法。P＜0.05可以认为有统计学意义。 结果： 本研究显示：异位妊娠行保守治疗人数逐年上升趋势。在天花粉和MTX两药治疗输卵管异位妊娠上，初始血β-HCG值是影响药物疗效的主要因素。随血β-HCG升高，天花粉和MTX的治愈成功率呈下降趋势，但天花粉治愈成功率皆高于MTX组。血β-HCG2000mIU/mL时，天花粉组药物治疗后血β-HCG下降速率明显快于MTX组；转阴时间短于MTX组；副作用无明显差异。高血β-HCG（≥2000mIU/mL）组天花粉的治愈成功率较低血β-HCG（2000mIU/mL）组成功率稍低，但成功率仍达75%，副作用安全可控，效果良好。天花粉与MTX对输卵管异位妊娠保守治疗后再次妊娠无明显差异及影响。 结论 输卵管异位妊娠中影响药物成功率的因素主要为初始血β-HCG。在异位妊娠保守治疗标准内（2000mIU/mL），天花粉是一种安全可行、成功率高的保守治疗药物，，住院时间短、转阴快、副作用在可控范围内、对日后妊娠暂无不良影响，与MTX相比，天花粉药物治疗各方面优于MTX药物治疗。天花粉药物保守治疗的安全适用范围为初始血β-HCG3000mIU/mL，治疗效果显著，副作用安全可控；在患者强烈要求药物保守治疗的意愿下，告知药物使用情况及风险，对于3000mIU/mL≤β-HCG5000mIU/mL的患者，天花粉药物仍有一定疗效，可根据情况使用。
[Abstract]:Objective to analyze retrospectively the data of patients with ectopic pregnancy in our hospital, and to explore the main influencing factors on the therapeutic effect of ectopic tubal pregnancy. The therapeutic effects and side effects of TCS and MTX on ectopic fallopian tube pregnancy were analyzed in order to grasp the scope of treatment for the clinicians. Selection of drug types and so on to provide clinical reference. Materials and methods the data of 230 cases of ectopic tubal pregnancy in gynecology and obstetrics department of Ruijin Hospital affiliated to Shanghai Jiaotong University Medical College from 2008 to 2012 were analyzed retrospectively. According to the type of drug treatment, the two drugs were divided into two groups: trichosanthin combination MTX group. The success rate, hospitalization time, blood 尾 -HCG, negative time, the decrease of blood 尾 -HCG, the side effect of drug and the influence of later pregnancy were compared between the two drugs used in ectopic tubal pregnancy. To compare the influence of patients' basic information and related background on conservative drug therapy. SPSS 19.0 statistical software was used to describe and analyze the data. The statistical methods included chi-square test and logistic regression analysis, etc. (P < 0.05). Results: this study showed that the number of ectopic pregnancy treated conservatively increased year by year. In the treatment of ectopic tubal pregnancy with trichosanthin and MTX, the initial serum 尾 -HCG level was the main factor affecting the therapeutic effect. With the increase of 尾 -HCG, the success rate of trichosanthin and MTX decreased, but the success rate of trichosanthin was higher than that of MTX. The decreasing rate of 尾 -HCG in trichosanthin group was faster than that in MTX group, the negative time was shorter than that in MTX group, and there was no significant difference in side effects. The success rate of Trichosanth in the high blood 尾 -HCG group (鈮

本文编号：2044781