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目的观察并探讨米非司酮与甲氨蝶呤二联保守治疗宫外孕临床疗效及安全性。方法选取我院妇科2009年3月至2011年10月收治宫外孕患者90例,采用随机数字表法分为两组,其中甲氨蝶呤组45例,采用常规甲氨蝶呤肌肉注射,甲氨蝶呤肌肉注射50mg/次,三天后再用一次;二联治疗组45例,甲氨蝶呤静脉推注20mg/次加用米非司酮片50mg,交替使用,共六天,用药第三天,第七天查血β-HCG;比较两组患者临床治疗总有效率,腹痛、盆腔包块及阴道流血等临床症状消失时间,一周内血清β-HCG指标下降超过15%例数、血清β-HCG恢复正常时间以及不良反应发生情况等。结果二联治疗组患者临床治疗总有效率明显高于甲氨蝶呤组,组间比较差异有统计学意义(P<0.05);二联治疗组患者腹痛、盆腔包块及阴道流血消失时间明显少于甲氨蝶呤组,组间比较差异有统计学意义(P<0.05);二联治疗组一周内血清β-HCG指标下降超过15%例数、血清β-HCG恢复正常时间等β-HCG指标变化情况明显优于甲氨蝶呤组,组间比较差异有统计学意义(P<0.05);同时甲氨蝶呤组患者治疗过程中出现不良反应6例,二联治疗组患者治疗过程中出现不良反应7例;两组患者不良反应发生率组间比较差异无统计学意义(P>0.05)。结论米非司酮与甲氨蝶呤二联保守治疗宫外孕临床疗效令人满意,能够有效缓解临床症状,降低血清β-HCG水平,且无严重不良反应发生。
Objective To observe and explore the clinical efficacy and safety of the combination of mifepristone and methotrexate in the treatment of ectopic pregnancy. Methods Ninety cases of patients with ectopic pregnancy were selected from March 2009 to October 2011 in our hospital. The patients were divided into two groups according to the random number table. Methotrexate group (n = 45) was treated with conventional methotrexate intramuscular injection, Retroflexus intramuscular injection of 50mg / time, once again three days; two treatment group 45 cases, methotrexate intravenous injection of 20mg / times with mifepristone tablets 50mg, alternating use, a total of six days, the third medication Days, the seventh day blood β-HCG; clinical efficacy of the two groups were compared clinical efficacy, abdominal pain, pelvic mass and vaginal bleeding and other clinical symptoms disappear within a week the serum β-HCG index decreased more than 15% of cases, serum β-HCG return to normal time and adverse reactions and so on. Results The total effective rate of clinical treatment in the two-treatment group was significantly higher than that in the methotrexate group, with significant difference between the two groups (P <0.05). The abdominal pain, pelvic mass and vaginal bleeding disappeared significantly in the two-treatment group Less than methotrexate group, the difference between the two groups was statistically significant (P <0.05); two weeks treatment group within a week serum β-HCG index decreased more than 15% number of cases, serum β-HCG recovery time β- HCG indicators were significantly better than the methotrexate group, the difference between the two groups was statistically significant (P <0.05); methotrexate treatment of patients with adverse reactions occurred in 6 cases, two treatment group treatment There were 7 cases of adverse reactions in the two groups; There was no significant difference between the two groups in the incidence of adverse reactions (P> 0.05). Conclusions The conservative treatment of ectopic pregnancy with mifepristone and methotrexate is satisfactory. It can effectively relieve the clinical symptoms and reduce the level of serum β-HCG without serious adverse reactions.