68例稳定型输卵管妊娠的药物治疗分析

The Effect Analysis of Meadicine Conservative Treatment about 68 Tubal Pregnancy of Stable Form

目的比较甲氨蝶呤单次大剂量和分次小剂量治疗输卵管妊娠的临床疗效,并观察影响药物治疗疗效的相关因素。方法2004年9月～2005年12月68例输卵管妊娠按甲氨蝶呤注射剂量与方法分为2组:A组38例,甲氨蝶呤一次注射100 mg为1个疗程;B组30例,甲氨蝶呤20 mg分次小剂量注射5 d为1个疗程。2组同时口服:①米非司酮片25 mg,2次／d,共3 d;②中药。比较2组的临床疗效。当2组疗效无差异(P>0．05)时再按疗效分组,观察治疗前不同血β-HCG值,及治疗1周后血β-HCG值下降率,包块直径等影响药物保守治疗成败的相关因素。结果甲氨蝶呤单次大剂量和分次小剂量治疗疗效及副作用无显著差异(P>0．05),但当血β-HCG值>3 000 IU／L,包块直径>4 cm,治疗1周后血β-HCG值下降率< 25％时,药物保守治疗失败的可能性会明显增加。结论甲氨蝶呤单次大剂量可取代分次小剂量治疗输卵管妊娠,且当包块直径<4 cm,血β-HCG值≤3 000 IU／L及其治疗一周后下降率<25％时,治疗输卵管妊娠有效。

Objective To compare the clinic effect of conservativet treatment of single flushing dose Methotrexate with that of fractionation small dose Methotrexate, on tubal pregnancy and observe the correlative factors which affect the clinic effect of conservative treatment on tubal pregnancy. Methods 68 tubal pregnant patients in Renming Hospital of Wuhan University from 2004 to 2005 were divided into two groups： Patients of Group A （n=38 pou ） were given single flushing dose of Methotrexate 100 mg for injection for one course of treatment. Patients of Group B （n=3o pou） were given fractionation small dose of Methotrexate for injection for one course of treatment （five days）. All the patients of both groups were given mifepristone orally 25 mg/d for three days together with the traditional Chinese medicine at the same time. We compared the difference of the clinic effect between the two groups and observe those correlative factors which may affect the clinic effect of conservative treatment on tubal pregnancy such as the blood β-HCG level, the reduction of blood β-HCG and lump diameter size and etc. Conclusion There is no significant difference of the clinic effects or side effects between the two groups, with blood β-HCG 〉 3000 IU/L, lump diameter size 〉 4 cm, reduction rate of blood β-HCG 〈 25% after one week of treatment, the abortive possibility of conservative treatment for tubal pregnancy increased significantly.