米非司酮联合甲氨蝶呤治疗宫外孕的安全性和有效性分析

Analysis of the Safety and Efficacy of Mifepristone Combined with Methotrexate in the Treatment of Ectopic Pregnancy

目的研究米非司酮联合甲氨蝶呤治疗宫外孕的临床安全性和有效性。方法选取2020年4月-2021年4月我院诊治的84例宫外孕患者为研究对象,采用随机数字表法分为对照组和观察组,各42例。对照组应用单纯甲氨蝶呤治疗,观察组在对照组基础上联合米非司酮治疗,比较两组临床疗效、临床症状改善时间、血清孕酮和人绒毛膜促性腺激素(β-HCG)水平、不良反应发生率以及1年内生育结局。结果观察组治疗总有效率为95.24%,高于对照组的83.33%(P<0.05);观察组包块和腹痛消失、阴道止血、血β-HCG转阴、孕酮恢复正常、月经复潮时间均短于对照组(P<0.05);两组治疗后血清孕酮、β-HCG水平均低于治疗前,且观察组低于对照组(P<0.05);观察组不良反应发生率与对照组比较,差异无统计学意义(P>0.05);随访1年,观察组宫内妊娠、再次宫外孕、未孕发生率与对照组比较,差异无统计学意义(P>0.05)。结论米非司酮联合甲氨蝶呤可提高临床治疗宫外孕的疗效,缩短临床症状改善时间,降低孕酮和β-HCG水平,且联合治疗不增加不良反应发生风险,也不影响1年内生育结局,是一种可行、有效的治疗方案。

Objective To study the clinical safety and efficacy of mifepristone combined with methotrexate in the treatment of ectopic pregnancy.Methods A total of 84 patients with ectopic pregnancy diagnosed and treated in our hospital from April 2020 to April 2021 were selected as the research objects.They were divided into control group and observation group by random number table method,with 42 cases in each group.The control group was treated with methotrexate alone,and the observation group was treated with mifepristone on the basis of the control group.The clinical efficacy,improvement time of clinical symptoms,serum progesterone and human chorionic gonadotropin(β-HCG)levels,incidence of adverse reactions and fertility outcomes within 1 year were compared between the two groups.Results The total effective rate of treatment in the observation group was 95.24%,which was higher than 83.33% in the control group(P<0.05).The time of mass and abdominal pain disappearance,vaginal hemostasis,blood β-HCG turning negative,progesterone returning to normal,and menstrual recovery in the observation group were shorter than those in the control group(P<0.05).After treatment,the levels of serum progesterone and β-HCG in the two groups were lower than those before treatment,and those in the observation group were lower than the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the observation group and the control group(P>0.05).After 1 year of follow-up,there was no significant difference in the incidence of intrauterine pregnancy,ectopic pregnancy and non-pregnancy between the observation group and the control group(P>0.05).Conclusion Mifepristone combined with methotrexate can improve the efficacy of clinical treatment of ectopic pregnancy,shorten the improvement time of clinical symptoms,reduce the levels of progesterone and β-HCG,and the combined treatment does not increase the risk of adverse reactions and does not affect the fertility outcome within 1 year.It is a feasible and effective treatment plan.