甲氨蝶呤在未破裂型异位妊娠中的疗效及不良反应分析

Analysis on the efficacy and adverse reactions of Methotrexate on unruptured ectopic pregnancy patients

目的对比研究甲氨蝶呤在未破裂型异位妊娠中的疗效及不良反应。方法将120例未破裂型异位妊娠患者根据随机数字表法分为三组,A组以20 mg甲氨蝶呤+5%葡萄糖注射液500 mL隔日静滴,并结合四氢叶酸解毒,B组采用50 mg甲氨蝶呤单次肌注治疗,C组在B组的基础上联合50 mg米非司酮,1次/d,持续7 d进行治疗。结果治愈率A、B、C三组分别为67.5%、90.0%和92.5%,B、C组不同治疗时期血β-人绒毛膜促性腺激素下降率及治愈率比较差异无统计学意义(P>0.05),但均明显优于A组(P<0.05);B组和C组异位妊娠包块缩小超过50%者显著高于A组(P<0.05);不良反应发生率分别为20.0%、22.5%和45.0%,C组高于A、B两组(P<0.05)。结论甲氨蝶呤单次肌内注射治疗方案较多次静脉滴注的治疗效果更好,虽有一定不良反应,但在停药后均能很快恢复正常,而加用米非司酮的方案未增加疗效,反而带来了更高的不良反应风险。

Objective To analyze the efficacy and adverse reactions of Methotrexate on unruptured ectopic pregnancy pa- tients. Methods 120 cases ruptured ectopic pregnancy patients were randomly divided into three groups according to random number tablethe, group A was treated with 20 mg Methotrexate ＋ 5% glucose injection 500 mL intravenous infusion every other day, combined with tetrahydrofolate detoxification; group B used 50 mg Methotrexate single intramuscular injection; on the basis of group B, group C was treated with joint Mifepristone 50 mg/d, once a day, treated cycle was 7 d. Results Cure rate of group A, B, C were 67.5%, 90.0% and 92.5%, there were no significant differences between group B and C in the cure rate and β-HCG descending rate （P 〉 0.05）, but they were significantly better than that in group A （P 〈 0.05）. Ectopic pregnancy mass reduction more than 50% or complete disappearance rate of group B and C were significantly higher than group A （P 〈 0.05）. The incidence of adverse reactions were 20.0%, 22.5% and 45.0%, group C was higher than group A, B （P 〈 0.05）. Conclusion A single intramuscular injection of Methotrexate regimen compared with repeated intravenous treatment is better, although there are some adverse reactions, but can quickly return to normal after stopping, while the addition of Mifepristone program does not increase efficacy, but brings higher risk of adverse reactions.