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目的探讨米非司酮联合甲氨蝶呤保守治疗异位妊娠的临床效果。方法米非司酮联合甲氨蝶呤组(A组):用甲氨蝶呤肌内注射0.4mg/(kg·d),5d为1个疗程并口服米非司酮100mg,12h/次,连续3d;甲氨蝶呤组(B组):单用甲氨蝶呤肌内注射0.4mg/(kg·d),5d为1个疗程。定期监测血β-HCG水平及B超监测包块情况直至正常。结果治愈率A组79·17%,B组77·27%,无统计学意义。A组较B组明显缩短血β-HCG降至正常所需的时间,减少住院日(P<0·01),但B组不良反应明显比A组少(P<0.05)。结论米非司酮联合甲氨蝶呤保守治疗可以使杀胚作用加强,促进胚囊坏死、吸收,在缩短血β-HCG转阴时间和平均住院日方面有良好的效果,但在不良反应如胃肠道反应、肝功能损害等明显增多,能否减少米非司酮的剂量来减少毒副反应有待进一步研究。
Objective To investigate the clinical effect of conservative treatment of ectopic pregnancy with mifepristone and methotrexate. Methods Mifepristone combined methotrexate group (A group): intramuscular injection of methotrexate 0.4mg / (kg · d), 5d for a course of treatment and oral mifepristone 100mg, 12h / time, Continuous 3d; methotrexate group (B group): single intramuscular injection of methotrexate 0.4mg / (kg · d), 5d for a course of treatment. Regular monitoring of blood β-HCG levels and B-monitoring mass until normal. Results The cure rate was 79.17% in group A and 77.27% in group B, with no statistical significance. Compared with group B, group A significantly shortened the time required for the reduction of blood β-HCG to normal and reduced the length of stay (P <0.01). However, the adverse reactions in group B were significantly less than those in group A (P <0.05). Conclusions Conservative treatment with mifepristone and methotrexate can enhance the effect of killing embryo, promote the necrosis and absorption of embryo sac, and have a good effect in shortening the blood time of β-HCG and average length of stay. However, in adverse reactions such as Gastrointestinal reactions, liver damage and other significantly increased, can reduce the dose of mifepristone to reduce side effects to be further studied.