不同用药方式甲氨蝶呤配伍米非司酮对高血β-HCG异位妊娠保守治疗体会

Clinical Analysis of Treatment for Ectopic Pregnancy by Different Administrations of Methotrexate Combined with Mifepristone

目的:探讨异位妊娠不同血β-HCG值(尤其高血β-HCG值)药物保守治疗的方法。方法:回顾性分析2006年1月-2007年6月我院161例经药物保守治疗异位妊娠的临床资料,按用药方式分为2组,其中A组80例,肌注甲氨蝶呤(MTX)+口服米非司酮;B组81例,静滴MTX+口服米非司酮。每组再按血β-HCG值高低分3组:血β-HCG<2 000 U/L,2 000 U/L～5 000 U/L以及>5 000 U/L 3组。于用药后第5、7、12天复查血β-HCG,观察其疗效。结果:A组中,30例血β-HCG<2 000 U/L者用药成功26例;28例血β-HCG2 000 U/L～5 000 U/L者中16例用药成功;22例血β-HCG>5 000 U/L者用药成功8例。B组中,31例血β-HCG<2 000 U/L者用药成功30例;28例血β-HCG2 000 U/L～5 000 U/L者用药成功24例;22例血β-HCG>5 000 U/L者用药成功18例。两组在血β-HCG2 000 U/L～5 000 U/L患者用药成功率比较有差异(P<0.05),血β-HCG>5 000 U/L患者用药成功率比较有显著差异(P<0.01)。结论:甲氨蝶呤静脉给药配合米非司酮治疗异位妊娠的成功率高。对于血β-HCG>5 000 U/L患者,采用间歇性大剂量用药配伍米非司酮保守治疗有优势。

Objective：To explore drug therapy of ectopic pregnancy with different plasma β-human chorionic gonadotropin（β-HCG）concentration（especially the high β-HCG level）.Methods：161 patients treated by drug therapy from January 2006 to January 2007 were analyzed retrospectively.They were divided into 2 groups according to different administrations：group A（80 cases,intramuscular injection of MTX and oral intake of mifepristone）,group B（81 cases,intravenous injection of MTX and oral intake of mifepristone）.Each group was sub-classified into 3 groups according to the level of β-HCG in serum：β-HCG2 000U/L,2 000U/L～5 000U/L,and 5 000U/L.β-HCG was examined on 5day,7day,and 12day after drug administration so as to analyze the curative and side effect.Results：For group A,26 cases（of 30 cases in sub-group β-HCG2 000U/L）got the curative effect,16 cases（of 28 cases in sub-group β-HCG 2 000U/L～5 000U/L）got the curative effect,8 cases（of 22 cases in sub-group β-HCG5 000U/L）got the curative effect.For group B,30 cases（of 31 cases in sub-group β-HCG2 000U/L）got the curative effect,24 cases（of 28 cases in sub-group β-HCG 2 000U/L～5 000U/L）got the curative effect,18 cases（of 22 cases in sub-group β-HCG5 000U/L）got the curative effect.There were statistical differences between group A and B in the second level（β-HCG 2 000U/L～5 000U/L）（P0.05）.There were significant differences between group A and B in the third level（β-HCG 5 000U/L）（P0.01）.Conclusion：The curative effect rate is high for the administration of intravenous injection of MTX and oral intake of mifepristone.Especially,for high β-HCG level patients,this administration has an advantage.