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目的探讨甲氨蝶呤(MTX)不同给药方式及联合米非司酮保守性治疗未破裂型输卵管妊娠的疗效及不良反应,以寻找最佳保守治疗方案。方法将自愿接受保守治疗并符合保守治疗要求的196例异位妊娠患者随机分成4组。A组52例,单次肌肉注射MTX 50 mg/m2,联合亚叶酸钙针隔日肌注解毒(比例1∶10);A0组48例,在A组方案的基础上加服米非司酮;B组47例,采用MTX 20 mg(0.4 mg/(kg.d))加入20 mL生理盐水每日静脉推注,连用5 d,第5天给予亚叶酸钙针肌注解毒(用量同上);B0组49例,在B组方案的基础上加服米非司酮。结果 A组成功率62%,A0组成功率83%,2组比较有显著性差异(P<0.05);B组成功率81%,B0组成功率96%,2组比较有显著性差异(P<0.05)。A组成功率与B组比较有显著性差异(P<0.05)。4组间不良反应采用Bonferroni法两两比较,均无显著性差异(P均>0.05)。结论使用MTX 5 d静推方案治疗未破裂型输卵管妊娠疗效好,且加用米非司酮可增加疗效而不增加药物的毒副反应。
Objective To investigate the efficacy and adverse reactions of methotrexate (MTX) in different modes of administration and conservative treatment of unruptured tubal pregnancy with mifepristone in order to find the best conservative treatment plan. Methods A total of 196 cases of ectopic pregnancy who were conservatively treated and conservatively treated were randomly divided into 4 groups. A group of 52 patients, a single intramuscular injection of MTX 50 mg / m2, combined with leucovorin every other day intramuscular injection of poison (ratio 1:10); A0 group of 48 patients, in group A program based on the addition of mifepristone; In group B, 47 patients were treated with MTX 20 mg (0.4 mg / (kg · d)) by daily intravenous bolus injection of 20 mL saline for 5 days, and leucovorin was intramuscularly detoxified on the 5th day (dosage as above). B0 group of 49 cases, in the B group based on the program plus mifepristone. Results The success rate of group A was 62% and that of group A0 was 83% (P <0.05). The success rate of group B was 81% and that of group B0 was 96%. There was significant difference between the two groups (P <0.05) . The success rate of group A was significantly different from that of group B (P <0.05). There was no significant difference between the 4 groups using Bonferroni method (P> 0.05). Conclusions The MTX 5-day push-push regimen is effective in treating unruptured tubal pregnancy, and the addition of mifepristone can increase the efficacy without increasing the side effects of the drug.