中西医结合治疗剖宫产术后子宫瘢痕妊娠的观察及护理

Observation and Nursing of Combined Treatment of Traditional Chinese Medicine and Western Medicine for Cesarean Section Scar Pregnancy

目的观察中药联合米非司酮和MTX治疗剖宫产后子宫瘢痕妊娠(GSP)的疗效和不良反应,并提出相应的护理措施。方法对2008年10月-2010年8月本院收治的96例患者,随机分为A、B两组,A组采用MTX局部注射杀胚胎治疗,同时服中药活血化瘀,待HCG下降至100IU/L时,在静脉麻醉宫腔镜下行清宫术。B组用MTX20mg肌肉注射,每天一次,连用5 d,并用米非司酮50mg口服,每12h一次,连用5d,待HCG下降至100IU/L,在静脉麻醉宫腔镜下行清宫术。结果 A组患者HCG下降到一半及正常的时间短于B组,总住院时间比B组短。A组出现恶心、呕吐、肝肾功能损害、血白细胞下降例数均较B组少。结论中药联合MTX局部注射治疗剖宫产术后子宫瘢痕妊娠HCG下降快,住院时间短,不良反应发生少,良好的护理措施可促进患者康复。

Objective To observe the curative effect and adverse reactions of traditional Chinese medicine（TCM） combined with mifepristone and methotrexate（MTX） for treatment of cesarean section scar pregnancy,and to provide the related nursing measures. Methods Ninety-six patients hospitalized in Maternal and Child Health Care Hospital of Hunan Province from October,2008 to August,2010 were randomly divided into group A and group B.The patients in group A were treated with local injection of MTX to kill embryos and simultaneously internally administrated TCM for promoting blood circulation.When the patients＇ HCG reduced to 100 IU/L,they received intravenous anesthesia,and then dilatation and curettage operations were performed under the uteroscope.The patients in group B were treated with intramuscular injection of 20 mg MTX once a day for 5 consecutive days,meanwhile,orally administrated 50 mg mifepristone once every 12h for 5 consecutive days.The patients were received intravenous anesthesia when the HCG reduced to 100 IU/L, and then dilatation and curettage operations were performed under the uteroscope. Results The time of HCG dropped to a half or normal in group A was less than that in group B,at the same time,the total hospitalization time in group A was also less than that in group B.The number of the patients who presented nausea,vomiting,liver and kidney dysfunction and white blood cell decrease was less than that of group B. Conclusions Local injection of MTX combined with traditional Chinese medicine in treatment of pregnancy on uterine scar after cesarean section can induce a fast decline of HCG,with the advantages of less time in hospital and fewer side effects.The comfortable and skilled nursing is beneficial to the patient＇s recovery.