甲氨蝶呤不同方案治疗输卵管妊娠的疗效及副反应分析

Efficacy and side effects of methotrexate in the treatment of ectopic pregnancy

目的 探讨甲氨蝶呤 (MTX)治疗输卵管妊娠的最佳剂量及给药途径。方法 回顾性分析 6 4 8例首选MTX治疗的未破裂输卵管妊娠 ,根据不同剂量及给药途径分为 6组 :MTX 10 0mg单剂量静脉推注 (组 1) ;MTX 10 0mg单剂量静脉推注 ,次日应用四氢叶酸 (组 2 ) ;MTX 10 0mg分 5d静脉推注 (组 3) ;MTX 10 0mg分 5d肌内注射 (组 4 ) ;MTX 75mg单剂量静脉推注 (组 5 ) ;MTX 75mg单剂量肌内注射 (组 6 )。比较 6组的重复给药率、成功率及副反应情况。结果 (1)各组重复给药率、成功率比较 ,差异无显著性 (P >0 0 5 ) ,总成功率为 88 1% ,重复给药率为 2 3 1%。 (2 )肝丙氨酸转氨酶异常发生率 ,组 1至组 6分别为 10 3%、8 3%、6 4 3%、6 9 1%、8 7%、31 0 %。组 1、组 2、组 5低于其他各组 ,各组比较 ,差异均无显著性 (P均 <0 0 5 )。 (3)白细胞下降、口腔溃疡及呕吐发生率 ,各组均较低 ,各组比较 ,差异无显著性 (P >0 0 5 )。结论 MTX相同剂量、不同给药途径治疗输卵管妊娠的疗效相似 ;75mgMTX单剂量静脉推注的副反应发生率较低 ,在输卵管妊娠保守治疗时可作为首选方案。

Objective To study the efficacy and side effects of methotrexate with different protocols in the treatment of ectopic pregnancy (EP). Methods Total of 648 patients who had EP and were treated only with MTX were analysed.Patients were divided into six groups according to protocol: Group 1,100 mg intravenously( IV); Group 2,100 mg, IV, followed by citrovorum factor; Group 3, 20 mg, IV every day for five days; Group 4, 20 mg intramusculary (IM) every day for five days; Group 5, 75 mg,IV; Group 6, 75 mg, IM.Results The rates of repeated MTX injection in group1～6 because of inadequate decrease of hCG were 23.3%,25.0%,21.4%,20.6%,24.4% and 22.4% respectively .Success rates were 87.4%,85.4%,90.5%,92.6%,86.3% and 91.4% respectively.Rates of liver dysfunction were 10.3%,8.3%,64.3%,69.1%,8.7% and 31.0%.Conclusion Single-dose of 75mg MTX IV injection may be the best regimen in the treatment of EP because of the same efficacy but the least side effects.