不同剂量甲氨喋呤对异位妊娠的疗效观察

A clinical observation of different methods of methotrexate in conservative treatment of ectopic pregnancy

目的探讨甲氨喋呤(MTX)联合米非司酮(Ru486)及单用MTX注射保守治疗异位妊娠的疗效比较。方法对256例患者行血绒毛促性腺激素(8-HCG)测定和B超检查,确诊异位妊娠后,应用随机分类法分为两组,A组119例采用MTX 50 mg/m^2单次肌注并加服Ru486 150 mg,MTX剂量≤80 mg/次;B组137例单用MTX治疗。用药5 d后两组若血β-HCG下降<15%,可再次用药。结果A组成功率88.23% (105/119),B组86.13%(118/137),两组比较差异无统计学意义(P>0.05)。第1个疗程成功率,A组71.42%(85/119),B组56.20%(77/137),两组比较差异有统计学意义(P<0.05)。MTX剂量:A组平均93.33 mg,B组113.37 mg,两组比较差异有统计学意义(P<0.05)。平均住院日:A组(9.1±3.6)d,B组(13.48±5.2)d,两组比较差异有统计学意义(P<0.01)。结论MTX与Ru486联合治疗异位妊娠效果确切,剂量小,疗程短,不良反应较微,是一种较理想的治疗方法。

Objective To discuss the effect of ectopic pregnancy between methotrexate（MTX） with mifepristone（Ru486） and single MTX injection. Methods 256 patients with confirmed ectopic pregnancy were randomly divided into group A and group B. Group A was treated by single MTX（50mg/m^2） injection and Ru486（≤80mg）, group B by single MTX injection. Five days after treatment, if Beta-HCG of woman in both groups decreased less than 15 % ,the treatment would continue. Results The successful rate of the therapy of group A was 88.23 % （105/ 119） and that of group B was 86.13 % （ 118/137 ） （P 〉 0.05 ） and no significant statistical difference was found. But the successful rate of first therapy of group A was 71.42% （85/119） and group B was 56.20% （77/137） （P 〈 0.05）, mean MTX dose of group A was 93.33mg and group B was 113.37mg（P 〈 0.05 ）, mean in-hospital days of group A were （9. 1 ± 3.6） and group B were （ 13.48 ± 5.2） （ P 〈 0.01 ）. There was significant difference between the two groups. Conclusion MTX combined with Ru486 was an effective and safe therapy in conservative treatment of ectopic pregnancy, whose side effect was small. It shortened the in-hospital days, and was a comparatively ideal therapy.