异位妊娠MTX保守治疗过程中破裂出血病例的临床分析

Clinical analysis of tubal rupture among ectopic pregnancy treated with methotrexate

目的:评价异位妊娠在MTX保守治疗过程中发生破裂出血的危险因素。方法:回顾性分析100例MTX保守治疗的异位妊娠妇女,主要测量指标为血浆HCG水平。结果:异位妊娠MTX保守治疗前、后HCG水平的上升速度与输卵管破裂出血密切相关;保守治疗给药前48 h HCG上升超过66%或给药后HCG仍持续性升高,则提示输卵管破裂可能性大;65%异位妊娠破裂出血在峡部。结论:MTX治疗前、后HCG上升的速度是预示输卵管破裂出血的良好指标;保守治疗给药前HCG上升速度超过66%/48 h或用药后HCG仍持续性升高,提示可能需要外科手术治疗;妊娠囊的着床部位也是输卵管破裂的高危因素。

Objective： To identify risk factors for tubal rupture among ectopic pregnancy treated with methotrexate （MTX）. Methods： Retrospective case - control analysis of one hundred women diagnosed with an ectopic gestation treated with MTX ： 20 patients experienced subsequent tubal rupture, and 70 patients experienced eetopie resolution. Results： The HCG incremental rate before as well as after MTX administration was positively associated with tubal rupture. HCG values prior to ectopic diagnosis that increased at least 66% over 48 hours and rising hCG values after treatment with MTX were independent predictors of tubal rupture. A disproportionate number （65%） of ectopic pregnancies that ruptured were located in the tuhal isthmus. Conclusion： The HCG incremental rate both before and after MTX represents an independent risk factor for subsequent tubal rupture. Concentrations of HCG before ectopic diagnosis that increased at least 66% over 48 hours, or persistently rising HCG concentrations after treatment with MTX, may lower the threshold for surgical intervention. Implantation site may represent an unidentifiable risk factor for tubal rupture.