甲氨蝶呤注射剂联合米非司酮片治疗植入性胎盘的临床研究

Clinical trial of methotrexate injection combined with mifepristone tablets in the treatment of placenta accreta

目的观察甲氨蝶呤注射剂联合米非司酮片治疗植入性胎盘的临床疗效及安全性。方法将植入性胎盘孕妇50例随机分为对照组24例和试验组26例。对照组予以常规止血、促宫缩、抗感染等治疗,试验组在对照组治疗的基础上,在超声引导下植入胎盘附近注射甲氨蝶呤每次60 mg,qd+米非司酮每次50mg,bid,口服,连续治疗10 d。比较2组患者的胎盘排出时间、阴道流血量、子宫内膜恢复时间、子宫复旧天数,以及药物不良反应的发生情况。结果治疗后,试验组和对照组的胎盘排出时间分别为(11.21±4.15)和(15.83±3.92)d,阴道流血量分别为(742.56±105.60)和(891.52±125.44)mL,子宫内膜恢复时间分别为(20.14±3.53)和(24.95±2.87)d,子宫复旧天数分别为(22.12±2.86)和(26.83±3.25)d,差异均有统计学意义(均P<0.05)。试验组的药物不良反应主要有肝损伤、消化道反应和口腔溃疡,对照组的药物不良反应主要有肝损伤。试验组和对照组的总药物不良反应发生率分别为15.38%和8.33%,差异无统计学意义(P>0.05)。结论甲氨蝶呤注射剂联合米非司酮片治疗植入性胎盘的临床疗效确切,且不增加药物不良反应的发生率。

Objective To observe the clinical efficacy and safety of methotrexate injection combined with mifepristone tablets in the treatment of placenta acereta. Methods A total of 50 pregnant women with pla- centa were randomly divided into control group （ n = 24 cases） and treat- ment groups （n = 26 cases）. Control group was treated with routine he- mostasis, contractions and anti -infection. Treatment group was given methotrexate 60 mg per time, qd, injected near the placenta accreta un- der ultrasound guidance ± mifepristone 50 mg per time, bid, orally, on the basis of control group, for 10 days. The placenta discharge time, va- ginal bleeding, endometrial recovery time, days of uterine involution and adverse drug reactions were compared between two groups. Results After treatment, the main indexes in treatment and control groups were compared： placenta discharge time were （11.21 ±4. 15 ） and （15.83 ±.92） d, vaginal bleeding were （742.56 ±105.60） and （ 891.52 ±125.44） mL, endometrial recovery time were （ 20. 14 ±3.53 ） and （24. 95 ±2. 87 ） d, days of uterine involution were （22. 12 ±2. 86） and （26. 83 ±3.25 ） d, the differences were statistically significant （ allP 〈 O. 05 ）. The adverse drug reactions in treatment group were liver injury, digestive tract reaction- and oral ulcer, which in control group were liver injury. The total incidences of adverse drug reactions in treatment and control groups were 15.38% and 8.33% without significant difference （ P 〉 O. 05 ）. Conclusion Methotrexate injection combined with mifepristone tablets has a definitive clinical efficacy in the treatment of placenta accreta, without increasing the incidence of adverse drug reactions.