甲氨蝶呤联合米非司酮不同方案治疗异位妊娠的临床研究

发布时间：2018-10-24 15:58

【摘要】：目的：比较甲氨蝶呤联合米非司酮不同用药方法治疗异位妊娠的临床疗效和不良反应,对其进行分析,以更好的指导临床治疗。方法：选取150例异位妊娠保守治疗患者,按甲氨蝶呤的不同给药方式分为A、B、C三组。A组50例,给予甲氨蝶呤小剂量分次肌肉注射方案：0.4mg/(kg·d)肌注,5d为一疗程；B组50例,给予甲氨蝶呤1mg/(kg·次),单次肌内注射；C组50例,采用经阴道超声引导下异位妊娠囊穿刺注药杀胚术(一次性注射甲氨蝶呤40mg)。三组均联合米非司酮25mg/次,每间隔12小时1次,连服3日。比较三组患者的疗效,包括成功率、β-HCG值变化情况、包块缩小幅度；记录不良反应,包括胃肠道反应、WBC下降、肝肾功能损伤等有无差异。结果：以最终采取手术治疗为保守治疗失败, A组成功率为88%,失败率为12%；B组成功率为92%,失败率为8%；C组成功率为90%,失败率为10%。三组成功率比较差异无统计学意义(P0.05)；三组患者血p-HCG于治疗后第4、7、10、14日比较差异均无统计学意义(P0.05)；三组患者治疗第7日和14日包块直径均值差异无统计学意义(P0.05)；在不良反应方面,A组不良反应总发生率为32%,B组不良反应总发生率为16%,C组不良反应总发生率为18%,A组和B组比较有统计学差异(P0.05),A组和C组比较有统计学差异(P0.05),但B组和C组比较差异无统计学意义(P0.05)。结论：三种不同方案对异位妊娠患者临床疗效均好且无差异,但甲氨蝶呤小剂量分次肌肉注射不良反应多,经阴道超声引导下异位妊娠囊穿刺注药增加了异位妊娠包块破裂的可能,而采用甲氨蝶呤单次肌内注射治疗方案不良反应小,应用便利,安全性高,有药物保守治疗适应症的患者,此疗法可作为首选方案。
[Abstract]:Aim: to compare the clinical efficacy and side effects of methotrexate combined with mifepristone in the treatment of ectopic pregnancy. Methods: one hundred and fifty patients with ectopic pregnancy were divided into three groups according to different methotrexate administration methods: group A (50 cases) received intramuscular injection of methotrexate (0.4mg/ (kg d) for 5 days, group B (50 cases) received intramuscular injection of methotrexate (50 cases), and group B (50 cases) received intramuscular injection of methotrexate for 5 days. Methotrexate 1mg/ (kg times), single intramuscular injection, group C (50 cases) were treated with transvaginal ultrasound guided ectopic pregnancy sac injection (one time injection of methotrexate 40mg). All the three groups were treated with mifepristone 25mg/ once every 12 hours for 3 days. To compare the efficacy of the three groups, including the success rate, the change of 尾-HCG value, the extent of mass reduction, and record adverse reactions, including gastrointestinal reaction, WBC decline, liver and kidney function injury. Results: the successful rate of conservative treatment was 88 in group A, the failure rate was 92 in group B, and the success rate was 90 in group C, and the failure rate was 100.Results: the successful rate of conservative treatment was 88% in group A, the failure rate was 92% in group B and the failure rate was 90% in group C, and the failure rate was 10% in group C. There was no significant difference in the success rate among the three groups (P0.05); there was no significant difference in blood p-HCG between the three groups (P0.05) on the 4th and 14th day after treatment (P0.05); there was no significant difference in the mean diameter of the 7th and 14th mass in the three groups (P0.05). In terms of adverse reactions, the total incidence of adverse reactions in group A was 320.The total incidence of adverse reactions in group B was 16. The total incidence of adverse reactions in group C was significantly higher than that in group B (P0.05). There was a statistical difference between group A and group B (P0.05), but that in group B was significantly higher than that in group B (P0.05). There was no significant difference between group C and group C (P0.05). Conclusion: the clinical efficacy of three different regimens in patients with ectopic pregnancy is good and there is no difference, but the adverse effects of low dose intramuscular injection of methotrexate are many. The possibility of rupture of ectopic pregnancy mass was increased by puncture of ectopic pregnancy sac under the guidance of transvaginal ultrasound. However, the single intramuscular injection of methotrexate had little adverse reaction, convenient application and high safety. This therapy can be used as the first choice for patients with conservative treatment indications.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.22

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