【摘要】：目的：比較甲氨蝶呤聯(lián)合米非司酮不同用藥方法治療異位妊娠的臨床療效和不良反應(yīng),對其進行分析,以更好的指導(dǎo)臨床治療。 方法：選取150例異位妊娠保守治療患者,按甲氨蝶呤的不同給藥方式分為A、B、C三組。A組50例,給予甲氨蝶呤小劑量分次肌肉注射方案：0.4mg/(kg·d)肌注,5d為一療程；B組50例,給予甲氨蝶呤1mg/(kg·次),單次肌內(nèi)注射；C組50例,采用經(jīng)陰道超聲引導(dǎo)下異位妊娠囊穿刺注藥殺胚術(shù)(一次性注射甲氨蝶呤40mg)。三組均聯(lián)合米非司酮25mg/次,每間隔12小時1次,連服3日。比較三組患者的療效,包括成功率、β-HCG值變化情況、包塊縮小幅度；記錄不良反應(yīng),包括胃腸道反應(yīng)、WBC下降、肝腎功能損傷等有無差異。 結(jié)果：以最終采取手術(shù)治療為保守治療失敗, A組成功率為88%,失敗率為12%；B組成功率為92%,失敗率為8%；C組成功率為90%,失敗率為10%。三組成功率比較差異無統(tǒng)計學(xué)意義(P0.05)；三組患者血p-HCG于治療后第4、7、10、14日比較差異均無統(tǒng)計學(xué)意義(P0.05)；三組患者治療第7日和14日包塊直徑均值差異無統(tǒng)計學(xué)意義(P0.05)；在不良反應(yīng)方面,A組不良反應(yīng)總發(fā)生率為32%,B組不良反應(yīng)總發(fā)生率為16%,C組不良反應(yīng)總發(fā)生率為18%,A組和B組比較有統(tǒng)計學(xué)差異(P0.05),A組和C組比較有統(tǒng)計學(xué)差異(P0.05),但B組和C組比較差異無統(tǒng)計學(xué)意義(P0.05)。 結(jié)論：三種不同方案對異位妊娠患者臨床療效均好且無差異,但甲氨蝶呤小劑量分次肌肉注射不良反應(yīng)多,經(jīng)陰道超聲引導(dǎo)下異位妊娠囊穿刺注藥增加了異位妊娠包塊破裂的可能,而采用甲氨蝶呤單次肌內(nèi)注射治療方案不良反應(yīng)小,應(yīng)用便利,安全性高,有藥物保守治療適應(yīng)癥的患者,此療法可作為首選方案。
[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.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R714.22

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