肌肉注射甲氨蝶呤治疗异位妊娠103例临床分析

Methotrexate therapy for ectopic pregnancy： A clinical analysis for 103 cases

目的探讨肌肉注射甲氨蝶呤（MTX）治疗异位妊娠成功的相关性因素，并将两种治疗方案进行比较。方法选取103例异位妊娠患者，分别予MIX以两种不同方案治疗：方案①（研究组）MTX0．4mg／（kg·d）肌注，连续5天为1疗程，（1个疗程43例，2个疗程9例，3个疗程3例）；方案②（对照组）MTX1mg／kg与CF5mg交替肌注qod连续6天为l疗程，（1个疗程34例，2个疗程12例，3个疗程2例）。分析MTX保守治疗成功的相关性因素；比较两种方案的疗效及药物毒副作用的发生率。结果两组患者在年龄、孕周、血β-HCG等方面的差异无显著性（P〉0．05）；保守成功患者的停经天数短于失败者（P〈0．05）、初始血β-HCG值低于失败者（P〈0．01）；研究组相比对照组治疗成功率高（85．5％vs62．5％，P〈0．01），住院天数短（15．7±7天vs18．0±6天，P〈0．05），但药物性肝功能损害更多见（56．4％vs10．4％，P〈0．01），外周血白细胞减少及口腔溃疡发生率无明显差异（P〉0．05）。结论严格选取MTX肌注保守治疗的病例，成功可能性大；因人制宜地选择药物治疗方案，在提高治愈率、缩短住院天数的同时，尽量减少MTX产生的毒副作用，建议治疗同时预防性使用保肝药物。

Objective To investigate the related factors that may affect the effectiveness of methotrexate（MTX）treatment for ectopic pregnancy,and to compare the effectiveness of two different regimem. Methods total number of 103 ectopic pregnancy cases were administered with MTX intramuscularly in two regimens respectively.For group one（ study group）,each therapeutic cy- cle includes 0.4 mg/（kg.d）persistence for 5 days（43 cases with 1 cycle,9 cases with 2 cycles,3 cases with 3 cycles）, for the other group（control group）, total 6 days as 1 mg/kg.d MTX with CF 5 mg/d in turns refers to one therapeutic cycle（34 cases with 1 cycle,12 cases with 2 cycles,2 cases with 3 cycles）.Analysis the correlation factors that may affect the effectiveness of MIX; Compare the efficacy and the incidence of the side affects of these two regimem.Results There were no significant differences of these two groups on age,gestafional age and serum β- HCG values（ P 〉 0.05） ;The amenozrhea days of patients with successful conservative treatment were less than that of the failure（ P 〈 0.05） ;Same was the initial serum β- HCG values（ P 〈 0.01） ;Study group compared with the control group had a higher success rate（85.5% vs 62.5%, P 〈 0.01）,and shorter hospitalization days （15.7 ± 7 d vs 18.0±6 d,P 〈 0.05）;However,drug-induced hepatitis in study group was much common（56.4% vs 10.4%, P〈 0.01）.The incidence of hypoleucceytosis and the oral ulcers had no significant difference（ P 〉 0.05） in the two groups. Conclusion It was benefit for selecting eases strictly for conservative treatment of ectopie pregnancy; Choose the personal- ized drug therapies to improve the curative effect and shorten the hospitalization days as well as to minimize the side effects of MTX. Using drugs proactively to protect liver function from damage was suggested during MTX treatment.