本文選題：異位妊娠 + 藥物保守治療　； 參考：《上海交通大學(xué)》2014年碩士論文

【摘要】：目的 本文通過(guò)回顧性分析我院異位妊娠藥物保守患者資料，探討影響輸卵管異位妊娠保守藥物治療療效的主要影響因素，以及通過(guò)天花粉（TCS）及甲氨蝶呤（MTX）2種保守藥物治療對(duì)輸卵管異位妊娠患者的療效和副作用、臨床使用意義等各方面分析，為臨床醫(yī)生把握藥物治療范圍、選擇藥物種類等提供臨床參考。 材料和方法 回顧性分析2008-2012年近5年上海交通大學(xué)醫(yī)學(xué)院附屬瑞金醫(yī)院婦產(chǎn)科輸卵管異位妊娠患者病史資料（共230例），并對(duì)患者進(jìn)行電話隨訪，對(duì)所得資料進(jìn)行整理。按藥物治療種類分為2種：天花粉組合MTX組，比較兩藥用于輸卵管異位妊娠的成功率、住院時(shí)間，血β-HCG、轉(zhuǎn)陰時(shí)間、用藥后血β-HCG下降情況、藥物副作用及日后妊娠的影響情況等；比較患者基本信息及相關(guān)背景對(duì)于藥物保守治療的影響意義。采用SPSS19.0統(tǒng)計(jì)軟件對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)描述和分析，統(tǒng)計(jì)方法包括卡方檢驗(yàn)、t檢驗(yàn)、Logistic回歸分析多因素等方法。P＜0.05可以認(rèn)為有統(tǒng)計(jì)學(xué)意義。 結(jié)果： 本研究顯示：異位妊娠行保守治療人數(shù)逐年上升趨勢(shì)。在天花粉和MTX兩藥治療輸卵管異位妊娠上，初始血β-HCG值是影響藥物療效的主要因素。隨血β-HCG升高，天花粉和MTX的治愈成功率呈下降趨勢(shì)，但天花粉治愈成功率皆高于MTX組。血β-HCG2000mIU/mL時(shí)，天花粉組藥物治療后血β-HCG下降速率明顯快于MTX組；轉(zhuǎn)陰時(shí)間短于MTX組；副作用無(wú)明顯差異。高血β-HCG（≥2000mIU/mL）組天花粉的治愈成功率較低血β-HCG（2000mIU/mL）組成功率稍低，但成功率仍達(dá)75%，副作用安全可控，效果良好。天花粉與MTX對(duì)輸卵管異位妊娠保守治療后再次妊娠無(wú)明顯差異及影響。 結(jié)論 輸卵管異位妊娠中影響藥物成功率的因素主要為初始血β-HCG。在異位妊娠保守治療標(biāo)準(zhǔn)內(nèi)（2000mIU/mL），天花粉是一種安全可行、成功率高的保守治療藥物，，住院時(shí)間短、轉(zhuǎn)陰快、副作用在可控范圍內(nèi)、對(duì)日后妊娠暫無(wú)不良影響，與MTX相比，天花粉藥物治療各方面優(yōu)于MTX藥物治療。天花粉藥物保守治療的安全適用范圍為初始血β-HCG3000mIU/mL，治療效果顯著，副作用安全可控；在患者強(qiáng)烈要求藥物保守治療的意愿下，告知藥物使用情況及風(fēng)險(xiǎn)，對(duì)于3000mIU/mL≤β-HCG5000mIU/mL的患者，天花粉藥物仍有一定療效，可根據(jù)情況使用。
[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

本文編號(hào)：2044781