氨甲喋呤单次肌内注射治疗异位妊娠

Single┐doseIntramuscularMethotrexateforTreatmentofEctopicPregnancy

目的：探讨氨甲喋呤（ＭＴＸ）单次肌内注射治疗异位妊娠的效果及适应证。方法：对２７例异位妊娠患者采用ＭＴＸ单次肌内注射（５０ｍｇ／ｍ２），不用四氢叶酸解毒方案治疗。定时监测血β－ｈＣＧ直至正常。结果：２４例成功，成功率８８．９％。成功与失败患者的孕龄、异位妊娠包块直径间的差异无显著性（Ｐ＞０．０５），但治疗前腹痛症状的发生率及血β－ｈＣＧ值间的差异有非常显著性（Ｐ均＜０．０１）。结论：早期诊断和严格选择病例是治疗成功的关键。无腹痛症状、异位妊娠包块直径≤５ｃｍ，血β－ｈＣＧ＜６０００ＩＵ／Ｌ为药物治疗的适应证。

Objective:Theeficacyandindicationofsingle-doseintramuscularmethotrexatetotreatearlyectopicpregnancywereexplored.Methods:27casesofectopicpregnancyweretreatedbysingle-doseintramuscularmethotrexate(50mg/m2)withoutcitrovorumrescue.Theβ-hCGwasmon-itoredre-gularlytilitbecamenormal.Twelveofthemrecievedthisregimeninoutpatientservice.Results:24cases(88.9%)weresuccessfulytreated.Threefailedandswitchedtooperation.Therewerenosignificantdiferences(P>0.05)ingestationalageandsizeofadnexaectopicmasbetweensucesfulcasesandfailedcases,buthighlysignificatdiferences(P<0.01)inoccurencerateofab-dominalpainandβ-hCGtitersbeforetreatment.Conclusion:Theearlydiagnosisandadherencetostrictcriteriaarethekeystosuccesfulmanagement.Noabdominalpain,ectopicmass≤5cmingreatestdimensionandtiterofserumβ-hCG<6000IU/Lweremainlyindicationsofdrugtreatment.