清热活血杀胚方联合复方米非司酮治疗未破裂型异位妊娠的临床观察

发布时间：2018-08-02 15:09

【摘要】：目的：探讨复方米非司酮联合清热活血杀胚方保守治疗未破裂型异位妊娠的效果，为临床的应用提供一定的数据支持和科学依据。方法：选择2012年6月-2013年9月湖北省中医院及武汉市第一医院妇产科住院部收治的56例未破裂型异位妊娠住院患者，随机分成两组，治疗组28例采用复方米非司酮配合口服清热活血杀胚方治疗，，对照组28例采用单纯复方米非司酮治疗。观察比较两组的临床疗效、治疗后血β-HCG降至正常水平所需要的时间、治疗后4周盆腔包块的直径大小、腹痛消失时间及有生育要求者输卵管通畅度的情况。结果： 1.治疗组28例患者有效22例，无效6例，有效率为78.57%。对照组28例患者有效15例，无效13例，有效率为53.57%。两组有效率比较，差异具有显著性（P0.05），治疗组疗效优于对照组。 2.治疗组有效者22例，治疗组治疗后血β-HCG降到正常水平所需要的时间为39.55±3.56d，对照组有效者15例，所需要的时间为41.53±4.00d，P0.05，说明两组在降低血β-HCG上无明显差异（P0.05）。 3.治疗组发现附件包块者19例，治疗后4周附件包块直径大小为0.48±0.28cm；对照组发现附件包块者10例，治疗后4周附件包块直径大小为1.50±0.39cm。治疗组在缩小附件包块上效果优于对照组，差异具有高度显著性（P0.01)。 4.治疗组腹痛患者17例，腹痛消失时间为5.71±0.92天；对照组腹痛患者10例，腹痛消失时间为10.00±1.25天。两组在腹痛消失时间上差异具有高度显著性（P0.01)，即治疗组治疗后腹痛时间较对照组短。 5.治疗组有17例有生育要求，其中有3例失访，对照组有15例有生育要求。治疗组14例，左侧输卵管通畅3例，右侧通畅3例，左右侧均通畅者5例，不通畅者3例。对照组15例，左侧输卵管通畅2例，右侧通畅1例，左右侧均通畅0例，不通畅者12例。两组在输卵管通畅性上的比较具有显著差异性（P0.01)，即治疗组治疗后输卵管通畅性较对照组好。结论：复方米非司酮联合清热活血杀胚方治疗未破裂型异位妊娠效果良好，能弥补单独使用西药的不足之处，使临床疗效提高，促进盆腔包块的吸收及消散，最大限度的恢复患者的生殖功能，减轻患者的精神负担。
[Abstract]:Objective: to explore the effect of compound mifepristone combined with Qingre Huoxue Shatian recipe for conservative treatment of unruptured ectopic pregnancy and to provide certain data and scientific basis for clinical application. Methods: from June 2012 to September 2013, 56 patients with unruptured ectopic pregnancy were randomly divided into two groups: Hubei traditional Chinese Medicine Hospital and Department of Obstetrics and Gynecology of the first Hospital of Wuhan City. The treatment group (28 cases) was treated with compound mifepristone combined with oral prescription of clearing heat and activating blood circulation to kill embryo, while the control group (28 cases) was treated with compound mifepristone alone. The clinical effects of the two groups were observed and compared. The time required for the blood 尾 -HCG to decrease to the normal level after treatment, the diameter of pelvic masses, the time of disappearance of abdominal pain and the patency of tubal tubes were observed and compared 4 weeks after treatment. Results: 1. In the treatment group, 22 cases were effective and 6 cases ineffective, the effective rate was 78.57. In the control group, 15 cases were effective and 13 cases ineffective, the effective rate was 53.57. The effective rate of the two groups was significantly higher than that of the control group (P0.05), the curative effect of the treatment group was better than that of the control group. 22 cases were effective in the treatment group, and the time required for the blood 尾 -HCG to decrease to the normal level in the treatment group was 39.55 卤3.56 days, while that in the control group was 15 cases, and the time required was 41.53 卤4.00 dP0.05, indicating that there was no significant difference between the two groups in reducing serum 尾 -HCG (P0.05). The diameter of adnexal mass was 0.48 卤0.28 cm in the treatment group and 1.50 卤0.39 cm in the control group 4 weeks after treatment. The effect of the treatment group on reducing the adnexal mass was better than that of the control group, and the difference was highly significant (P0.01). In the treatment group, 17 patients with abdominal pain disappeared for 5.71 卤0.92 days, while the control group for 10 patients with abdominal pain, the time for the disappearance of abdominal pain was 10.00 卤1.25 days. There was a significant difference between the two groups in the disappearance time of abdominal pain (P0.01), that is, the time of abdominal pain in the treatment group was shorter than that in the control group (P0.01). In the treatment group, 17 cases had fertility requirement, 3 cases were lost, and 15 cases in the control group. In the treatment group, there were 14 cases of tubal patency, 3 cases of left tubal patency, 3 cases of right side patency, 5 cases of left and right side patency, 3 cases of unpatency. In the control group, there were 15 cases, 2 cases of left tubal patency, 1 case of right side patency, 0 cases of left and right side patency, 12 cases of unpatency. There was significant difference between the two groups in the oviduct patency (P0.01), that is, the treatment group was better than the control group after treatment. Conclusion: compound mifepristone combined with clearing heat and activating blood circulation to kill embryo is effective in treating unruptured ectopic pregnancy, which can make up for the deficiency of western medicine alone, improve the clinical efficacy and promote the absorption and dissipation of pelvic mass. To maximize the recovery of the reproductive function of patients, reduce the mental burden of patients.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.22

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