异位消方联合米非司酮治疗未破损期异位妊娠的临床观察

发布时间：2019-05-22 18:14

【摘要】：目的:异位妊娠(ectopic pregnancy EP)患者通过中药异位消方联合米非司酮方案的诊治,对两组2周治疗周期的短期治疗效果、血绒毛膜促性腺激素(β-HCG)值下降的水平及下降到正常值所消耗的时间,盆腔包块缩小范围及消失所需时间,用药后的不良反应以及对肝肾功能及造血功能的损害等情况进行临床观察:讨论活血消ve中药异位消方配合米非司酮对未破损期输卵管妊娠疾病的作用机理及临床使用的可行性,为临床应用提供可靠的药物使用根据。方法:对70例2015年04月-2016年02月河南省中医院妇科的未破损期输卵管妊娠者,符合标准者纳为研究对象,随机将70例符合标准者分成2组,每组35例患者;治疗组中有1例因血β—HCG值快速升高改用甲氨蝶呤(MTX)+米非司酮二联杀胚方案,1例治疗过程中自行离院;对照组中2例因腹腔出血、包块持续增大行急诊手术,另2例因私人原因放弃,依标准剔除,故最终治疗组33例,对照组31例患者。治疗组采用异位消方配合米非司酮综合治疗;对照组单纯口服米非司酮;对照组清晨温水送服米非司酮片50mg,前、后2小时均禁食饮水,连服3天;治疗组在按照上述方法服用米非司酮的同时服用异位消方并随症加减,一日一剂,早晚分服,1周为一个疗程,共2个疗程,在用药后的第3、7、14天抽血监测β-HCG结果,B超每周检查1次。最终对两组的整体疗效、血β-HCG值下降的水平、妊娠包块缩小范围,血β-HCG值下降到正常所消耗时间、妊娠包块吸收的耗时、用药后的不良反应、对肝肾功能及对造血功能的损害进行对比。结果:(1)比较治疗组和对照组总有效率情况:治疗组为93.93%,对照组为74.19%,两组比较差异有显著性(P0.05);(2)用药后第3、7、14天,治疗组监测血β-HCG(单位:m IU/ml)值分别为253.83±240.41、53.68±38.53、3.32±2.99,对照组治疗后分别为365.82±253.42、118.28±138.70、15.63±27.33,治疗组与对照组在服药后第3、7、14天分别比较血β-HCG值均有显著性差异(P0.05);(3)治疗组和对照组血β-HCG值下降到正常所需时间(单位:天)分别为13.85±2.10、16.03±3.58,两组对比有显著性差异(P0.05);(4)治疗组用药后第7、14天妊娠包块的最大直径(单位:mm)分别为13.43±5.78、5.88±4.17,对照组分别为14.03±4.09、7.55±3.38,两组对比差异具有显著性(P0.05);(5)治疗组和对照组妊娠包块消失所需时间(单位:天)分别为19.73±6.65、25.74±8.92,两组对比具有显著性差异(P0.05);(6)在服药后不良反应的发生率上,治疗组和对照组进行比较,前者为9.09%,后者为22.58%,差异具有统计学意义(P0.05);(7)治疗组和对照组对肝功及白细胞损害的出现率进行比较,治疗组为9.09%,而对照组为45.16%,两组对比,差异有显著性(P0.05);结论:异位消方因其较强的活血化瘀、杀ve消胚作用与米非司酮的抗孕激素作用联合应用,可以快速杀胚、使血β-HCG值的快速下降,缩短异位妊娠包块缩小至正常所需时间、减轻对肝肾功能及造血功能的损害,是一种保守治疗未破损期异位妊娠的行之有效的方法。
[Abstract]:Objective: In the treatment of ectopic pregnancy (EP) in the treatment of two-week treatment, the short-term treatment effect of the two-week treatment cycle, the level of the decrease of the value of the chorionic gonadotropin (HCG) and the time consumed by the normal value were measured. The time required for the reduction of the pelvic mass, the time required for the disappearance, the adverse reaction after medication and the damage to the function of the liver and the kidney and the function of the hemopoietic function were observed: To discuss the mechanism of Huoxue elimination and the feasibility of the use of mifepristone in the non-damaged tubal pregnancy, and to provide reliable drug use according to the clinical application. Methods:70 patients with non-damaged tubal pregnancy from April 2015 to February 2016 were randomly divided into 2 groups according to the standard, and 35 patients in each group were randomly divided into two groups. In the treatment group, one case was treated with methotrexate (MTX) + mifepristone in one case, and one case was separated from the hospital during the course of treatment; in the control group,2 cases were given emergency operation due to abdominal hemorrhage, and the mass was continuously increased, and the other two cases were discarded according to the standard, and the other two cases were rejected according to the standard. Therefore,33 patients in the final treatment group and 31 patients in the control group. In the treatment group, the treatment group was treated with mifepristone in combination with mifepristone; the control group was treated with mifepristone alone; in the early morning, the control group was fed with mifepristone tablets for 50 mg, and the water was fasted for 3 days before and after 2 hours; In the treatment group, after taking mifepristone according to the above method, the treatment group received the mifepristone and added and added with the addition and the addition of the mifepristone, one dose of the day and the morning and the evening, one week for one course of treatment,2 courses of treatment, and the results of the monitoring of the HCG-HCG on the third, the 7th and the 14th day after the administration are taken, and the B-ultrasonic examination is performed once a week. And finally, the whole curative effect of the two groups, the level of the reduction of the value of the blood-HCG-HCG, the reduction range of the lump of the pregnancy, the reduction of the value of the HCG-HCG to the normal consumption time, the time-consuming and the adverse reaction after the medication, the function of the liver and the kidney and the damage to the hemopoietic function are compared. Results: (1) The total effective rate of the treatment group and the control group was 93.93% in the treatment group, 74.19% in the control group and 74.19% in the control group (P <0.05). (2) The values of the blood pressure-HCG (unit: m IU/ ml) in the treatment group were 253.83, 240.41, 53.68, 38.53, 3.32 and 2.99, respectively. The control group was 365.82, 253.42, 118.28, 138.70, 15.63, 27.33, respectively. The treatment group and the control group had significant difference (P0.05). (3) The value of HCG in the treatment group and the control group decreased to the normal time (unit: day) of 13.85, 2.10, 16.03 and 3.58, respectively. There was a significant difference between the two groups (P0.05). (4) The maximum diameter (in mm) of the 7th and 14th day of the treatment group was 13.43, 5.78, 5.88 and 4.17, respectively, and the control group was 14.03, 4.09, 7.55 and 3.38, respectively (P0.05). (5) The time required for the disappearance of the treatment group and the control group (unit: day) was 19.73, 6.65, 25.74 and 8.92, respectively (P0.05). (6) The treatment group and the control group were compared with the control group, the former was 9.09%. The latter was 22.58%, the difference was statistically significant (P0.05); (7) the rate of liver work and white blood cell injury was compared in the treatment group and the control group, the treatment group was 9.09%, and the control group was 45.16%, and the difference was significant (P0.05); due to the combination of the anti-progestogen effect of the mifepristone and the anti-progestogen effect of the mifepristone, the ectopic pregnancy-eliminating party can quickly kill the embryo, And is an effective method for conservative treatment of non-damaged ectopic pregnancy.
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R714.22

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