氨甲蝶呤、米非司酮联合中药治疗异位妊娠的临床研究

目的探讨氨甲蝶呤(MTX)、米非司酮联合中药保守治疗异位妊娠的临床疗效。方法将50例异位妊娠患者随机分为治疗组和对照组各25例,治疗组予以MTX、米非司酮联合中药治疗,对照组予以MTX联合米非司酮治疗。观察并记录患者临床症状和体征的变化,动态检测血β-绒毛膜促性腺激素(β-hCG)的变化,定期B型超声监测盆腔内异位妊娠包块及直肠子宫陷凹积液的变化,比较2组用药后第7天血β-hCG下降率、血β-hCG下降至正常时间、盆腔内异位妊娠包块及直肠子宫陷凹积液吸收时间、月经恢复时间。结果治疗组血β-hCG下降率高于对照组,血β-hCG下降至正常所需时间、盆腔内异位妊娠包块吸收时间、直肠子宫陷凹积液吸收时间、月经恢复时间短于对照组,差异均有统计学意义(P<0.05)。结论 (1)MTX、米非司酮联合中药保守治疗异位妊娠疗效明显优于MTX联合米非司酮治疗。(2)MTX、米非司酮联合中药治疗异位妊娠能更早地恢复排卵功能,促进胚胎组织吸收,更大程度恢复输卵管畅通功能,并减少持续性异位妊娠和重复性异位妊娠的发生,最大限度地保留患者的生育能力。(3)本法应用于异位妊娠,充分发挥了中西医结合治疗异位妊娠的优势,避免了手术治疗,减轻了患者的精神及经济负担,同时提高了患者的生活质量。

Clinical Study of MTX and mifepristone combined with Chinese herbal medicine in the treatment of ectopic pregnancy

Objective To research the clinical effect of the therapy of methotrexate （MTX） and mifepristone com- bined with Chinese herbal medicine in the treatment of ectopic pregnancy （EP）. Methods 50 cases of EP patients were ran- domly divided into treatment group and control group, each of 25 cases. The treatment group was given MTX, mifepristone and Chinese herbal medicine for treatment. The control group was treated with MTX and mifepristone. Observe the changes of clini- cal symptoms and signs ,the level of serum 3-hCG,the size of adnexal mass and rectouterine pouch effusion by abdominal ultra- sound between the 2 groups. After seven days for treatment, compare the average decreasing rate of 3-hCG, the time of decrea- sing normal level of serum 3-hCG, the disappearance of the adnexal masses and the rectouterine pouch fluidify, the restoration of normal menstruation of 2 groups. Results The average decreasing rate of 3-hCG after seven days for treatment in the treat- ment group was higher than that of the control group. The average time of serum I3-hCG restoring to normal level, the disappear- ance time of the adnexal masses, the absorbed time of the rectouterine pouch effusion and the average time of restoring menstru- ation in the treatment group were obviously shorter than those of the control, there were significant differences between the 2 groups （P 〈 0.05 ）. Conclusion （ 1 ） The cure effect of MTX and mifepristone combined with Chinese herbal medicine in the treatment of ectopic pregnancy was superior to that of employing MTX and mifepristone. In addition,the side effects of the therapy were low. （2） The therapy of combining MTX, mifepristone and Chinese herbal medicine could utmostly restore ovula- tion function, improve the absorption of embryonic tissue, restore the tubal smooth function, reduce the occurrence of persistent ectopic pregnancy, recurrent ectopic pregnancy and reserved the Potentia Generandi of the patient, （3） The therapy of combi- ning MTX, mifepristone and Chinese herbal medicine sufficiently bring combined treatment of traditional Chinese medicine and western medicine into full play, which could avoid the operation treatment, lessened the mental and economic burden of the pa- tient and raised the quality.