甲氨蝶呤配伍米非司酮及中药保守治疗异位妊娠的疗效

目的探讨甲氨蝶呤（MTX）配伍米非司酮及中药保守治疗异位妊娠的临床疗效。方法将90例行保守治疗的异位妊娠患者按随机数字表法分为MTX组（44例）和MTX＋米非司酮＋中药组（46例）。MTX组给予MTX 50 mg,隔日肌内注射,共3次。MTX＋米非司酮＋中药组给予米非司酮50 mg,2次.d-1,4 d为1个疗程;中药：丹参、赤芍各15 g,桃仁9 g,三棱、莪术各6 g,厚朴、积实各3 g,煎服,2次.d-1,7 d为1个疗程;MTX用法同MTX组。疗程结束后测定肝肾功能及血常规1次。以后每周测1次血人绒毛膜促性腺激素（β-HCG）,B超复查盆腔包块,当β-HCG降至正常后停药。对2组β-HCG水平的变化及疗效进行比较。结果出院后随访1个月,MTX＋米非司酮＋中药组总有效率为89.1%,MTX组总有效率为75.0%,2组比较差异有统计学意义（P〈0.05）。MTX＋米非司酮＋中药组血β-HCG降至正常时间为（3.2±1.0）周,MTX组血β-HCG降至正常时间为（4.5±0.9）周,2组比较差异有统计学意义（P〈0.05）。结论 MTX配伍米非司酮及中药保守治疗异位妊娠安全可靠。

Curative Efficacy of MTX Combined with Mifepristone and Traditional Chinese Medicine in Conservative Treatment of Ectopic Pregnancy

Objective To investigate the curative efficacy of MTX combined with mifepristone and traditional Chinese medicine in conservative treatment of ectopic pregnancy. Methods Ninety patients with ectopic pregnancy received conservative treatment with intramuscular injection of 50 mg MTX every other day （3 times）alone （MTX group, n=44）or in combination with 50 mg mifepristone twice daily for 4 days and traditional Chinese medicine decoction （15 g Radix Salviae Miltiorrhizae, 15 g Radix Paeoniae Rubra, 9 g peach kernel, 6 g trigonous, 6 g zedoary, 3 g Magnolia and 3 g frnctus aurantii immaturns） twice daily for 7 days （combination group, n=46）. Changes in blood β-HCG levels and curative effects were compared between the two groups. Liver and kidney functions were measured and blood routine examination was performed once. Then, blood β-HCG levels were detected and pelvic mass was reexamined once a week. Drug withdrawal was performed when β-HCG level returned to normal. Results After 1 month of follow-up, the total effective rate in MTX group was significantly lower than that in combination group（75.0% vs 89.1%,P〈0.05）. Moreover, the time to β-HCG dropping to normal in MTX group was significantly longer than that in combination group （4.5±0.9） weeks vs （3.2±1.0）weeks,P〈0.05）. Conclusion The conservative treatment with MTX, mifepristone and tradit- ional Chinese medicine is safe and reliable for treating ectopic pregnancy.