| | | 甲氨蝶呤联合米非司酮治疗异位妊娠的疗效观察
| | 免费论文【摘要】 目的免费论文 探索异位妊娠保守治疗的免费论文最佳疗效方案。方法 本院249例异位妊娠患者，其中125例行保守治疗。按用药随机分为A组42例： 甲氨蝶呤(MTX) 50mg/m2单次肌肉注射并口服米非司酮，B组42例：MTX单次肌肉注射(50 mg/m2)，C组41例：米非司酮，定期监测血β-HCG水平及阴道B超监测包块情况直至正常。结果 治愈率A组85.7%，B组83.3%，C组60.9%，A、B两组较C组明显缩短血β-HCG降至正常所需的时间，减少住院日(P<0.01)，A、B两组间没有明显的差异(P＞0.05)，但B组副反应明显比A组少(P<0.05)。结论 MTX单次肌肉注射治疗异位妊娠疗效好、副反应少。
【关键词】 异位妊娠； 药物治疗； 甲氨蝶呤； 米非司酮
Observation on the curative effect of MTX combined with mifepristone in the treatment of ectopic pregnancy
【Abstract】 Objective To explore a best therapy regimen for conservative treatment of ectopic pregnancy.Methods 125 women of total 249 inpatients with ectopic pregnancy underwent medicine therapy in Xianghe Hospital of Xiangtan.They were divided into three groups： Group A (42 cases) was treated with (MTX) single-dose (50mg/m2) intramuscular injection combined with oral mifepristone (RU486)， Group B (42 cases) was treated with (MTX) single-dose (50mg/m2) intramuscular injection only， and the Group C (41 cases) was treated with oral mifepristone only. After treatment，the serum β-HCG levels and transvaginal B-ultrasonic inspection were examined until retum to normal level.Results Cure rate for ectopic pregnancy was 85.7% in Group A. it was 83.3% and 60.9% in Group B and Group C，respectively. The shorten time that β-HCG retum to normal level， less time of hospitalization in Group A and Group B significantly differed from the Group C (P<0.01). But there was no difference between Group A and Group B (P＞0.05). However， The side effect in Group B was less than Group A (P<0.05).Conclusion The single-dose MTX intramuscular injection in treating ectopic pregnancy is a highly effective and fewer side effect，and higher safety.
【Key words】 ectopic pregnancy；medicine therapy； methotrexate；mifepristone
随着血β-HCG测定的灵敏度增强，阴道B超早期诊断技术的提高以及医生对异位妊娠的高度警惕，许多异位妊娠在破裂或流产前都得以诊断，为药物保守治疗提供了条件。如何提高药物治疗的成功率并降低副反应成为人们关注的焦点。现将我们使用MTX联合米非司酮治疗异位妊娠的情况报告如下。
1 资料与方法
1.1 资料来源及分组方法 1999年9月～2006年8月在本院妇产科经血β-HCG测定和阴道B超检查诊断为异位妊娠者249例，其中125例行保守治疗。所有患者都住院治疗，并按用药随机分为3组。A组：42例，采用MTX联合米非司酮治疗；B组：42例，单用MTX治疗；C组：41例，单用米非司酮治疗。3组之间在年龄、孕产次、停经时间、入院时血β-HCG值、包块直径等差异无显著性（P>0.05）。见表1。
1.2 诊断依据及适应证的选择［1，2］ (1)有停经史或虽无停经史但有异常出血史，伴或不伴有腹痛；尿HCG阳性：(2)生命体征平稳，无活动性腹腔出血；(3)超声显示附件包块≤5cm，无血管搏动，直肠子宫凹陷积液≤3.0cm；(4)刮宫后血清β-HCG呈持续异常升高，血β-HCG<2000U/L；(6)输卵管妊娠未发生破裂或流产；(6)无肝肾功能障碍及血象异常，外周血白细胞≥4.0×109/L，血小板≥100×109/L；(7)无药物治疗的禁忌证。表1 3组一般情况的比较 注：3组间比较，通过F检验，各组间P>0.05，差异无显著性
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