甲氨蝶呤联合米非司酮不同给药方式治疗异位妊娠患者临床研究

Clinical research on methotrexate joint mifepristone in treating patients with ectopic pregnancy

目的:探讨甲氨蝶呤联合米非司酮不同给药方式治疗异位妊娠的临床疗效。方法:将2013年12月至2015年5月我院收治的96例异位妊娠患者随机分为对照组(46例)和观察组(50例),对照组采用肌肉注射甲氨蝶呤0.4 mg/kg·d×5d联合米非司酮口服治疗,观察组采用单次肌肉注射甲氨蝶呤1mg/kg联合米非司酮口服治疗,比较两组临床疗效。结果:观察组治愈率为94.0%(47/50),明显高于对照组的78.3%(36/46),差异有统计学意义(P<0.05);相比于对照组,观察组血β-HCG转阴及包块消失时间均明显减少,差异有统计学意义(P<0.05);两组治疗前后孕酮及血β-HCG水平变化明显,且观察组治疗后血β-HCG和孕酮水平明显低于对照组,差异有统计学意义(P<0.05);观察组总不良反应发生率为32.0%(16/50),明显低于对照组的52.1%(11/46),差异有统计学意义(P<0.05)。结论:在口服米非司酮基础上按表面积一次性大剂量注射MTX治疗异位妊娠有助于降低血β-HCG和孕酮水平,提高治疗成功率,安全性高,可在临床上推广应用。

Objectives： To investigate the clinical effect of methotrexate combined with mifepristone in treating patients with ectopic pregnancy. Methods： The 96 patients with ectopic pregnancy in our hospital from December 2013 to May 2015 were randomly divided into observation group（ 50 cases） and control group（ 46 cases）. Control group was treated with intramuscular injection of methotrexate 0. 4 mg / kg·d × 5d combined with mifepristone,while observation group was treated with single intramuscular injection of methotrexate 1mg / kg combined with mifepristone. The clinical effect of the two groups was compared. Results： The cure rate of observation group was 94%（ 47 /50）,significantly higher than the control group（ 78. 3%,36 /46）,with statistically significant difference（ P〈 0. 05）. Compared with control group,the mass disappearance time and serum β- HCG negative time of observation group was significantly shortened,with statistically significant difference（ P〈 0. 05）. Compared with those before treatment,the levels of serum β- HCG and progesterone in the two groups were significantly decreased after treatment,and the levels of serum β- HCG and progesterone in the observation group were significantly lower than the control group,with statistically significant difference（ P〈 0. 05）. The total adverse reaction rate of the observation group was 32%（ 16 /50）,significantly lower than the control group（ 52. 1%,11 /46）,with statistically significant difference（ P〈 0. 05）. Conclusion： Single large dose of MTX combined with mifepristone in patients with ectopic pregnancy can reduce the level of serum β- HCG and progesterone,and improve the success rate of treatment and security,which can be popularized in clinical application.