消癥复通汤联合甲氨蝶呤治疗异位妊娠的临床疗效研究

目的　研究消癥复通汤联合甲氨蝶呤治疗异位妊娠的临床治疗效果，为中西医结合治疗提供临床用药依据。方法　以滕州市中心人民医院2020年1月至6月因异位妊娠保守治疗患者80例为研究对象，按照是否采用中西药结合治疗方法随机分为两组，各40例。对照组年龄（30.45±6.00）岁，单用甲氨蝶呤治疗；观察组年龄（31.32±3.93）岁，采用消癥复通汤联合甲氨蝶呤治疗。比较两组患者年龄、停经天数、腹痛天数、阴道流血天数、血人绒毛膜促性腺激素（HCG）、孕酮、异位妊娠包块及子宫内膜厚度。比较整个治疗周期内两组治疗效果，同时观察药物不良反应。采用独立样本t检验、χ²检验或Fisher确切概率法进行统计学比较。结果　观察组药物治疗失败行手术治疗者2例，治疗成功者38例（95.00%）；对照组治疗失败者10例，治疗成功者30例（75.00%）；两组治疗成功率比较差异有统计学意义（χ²=6.275，P=0.012）。两组患者治疗后第7天血HCG及住院费用比较，差异均无统计学意义（均P>0.05）；观察组治疗后第7天异位妊娠包块、血HCG降至正常时间、异位妊娠包块消失时间、住院时间分别为（2.14±0.92）cm、（14.61±4.76）d、（26.24±9.75）d、（7.16±3.11）d，均低于对照组（2.61±0.80）cm、（17.47±6.01）d、（32.50±12.98）d、（8.87±3.61）d，差异均有统计学意义（均P<0.05）。治疗前，两组患者血管内皮生长因子（VEGF）、肌酸激酶（CK）、抑制素A（INH-A）水平比较，差异均无统计学意义（均P>0.05）；治疗后，观察组VEGF、CK、INH-A水平分别为（83.17±35.31）μg/L、（33.07±10.04）U/L、（6.86±2.36）μg/L，均低于对照组（103.50±39.16）μg/L、（38.71±7.31）U/L、（8.05±2.03）μg/L，差异均有统计学意义（均P<0.05）。结论　消癥复通汤联合甲氨蝶呤能够加快异位妊娠患者包块的吸收，促进HCG降至正常，减少患者住院天数，中西药结合治疗方法疗效显著，无不良反应，可在临床上进行推广。

Clinical effect of Xiaozheng Futong decoction combined with methotrexate in the treatment of ectopic pregnancy

Objective　To investigate the clinical effect of Xiaozheng Futong decoctioncombined with methotrexate in the treatment of ectopic pregnancy, and toprovide a basis for clinical use of integrated traditional Chinese and chemicalmedicine in the treatment of this disease. Methods　Eighty patients were treated conservatively for ectopic pregnancy inTengzhou Central People's Hospital from January to June 2020, and according tothe treatment methods, the patients were randomly divided into two groups with40 cases in each group. The control group was (30.45±6.00) years old, and theobservation group was (31.32±3.93) years old. The control group was treatedwith methotrexate alone and the observation group was treated with XiaozhengFutong decoction combined with methotrexate. The age, days of menopause, daysof abdominal pain, days of vaginal bleeding, human chorionic gonadotropin(HCG), progesterone, ectopic pregnancy mass, and endometrial thickness werecompared between the two groups. The clinical effects of the two groups werecompared during the whole treatment cycle, and the adverse drug reactions wereobserved. Independent sample t test, χ² test, and Fisher exactprobability test were used for the statistical comparison. Results　In the observation group, there were 2 cases of failure of drug therapyand transferred to operation, and 38 successful cases (95.00%); in the controlgroup, there were 10 cases of failure and 30 successful cases (75.00%); therewas a statistically significant difference in the success rate between the twogroups (χ²=6.275, P=0.012). There were no statisticallysignificant differences in the blood HCG on the 7th day after treatment andhospitalization cost between the two groups (both P>0.05). In the observation group, the ectopic pregnancy mass onthe 7th day after treatment, time of blood HCG returning to normal, time ofectopic pregnancy mass disappearance, and hospital stay were (2.14±0.92) cm,(14.61±4.76) d, (26.24±9.75) d, and (7.16±3.11) d, respectively, which were alllower than those in the control group [(2.61±0.80) cm, (17.47±6.01) d,(32.50±12.98) d, and (8.87±3.61) d], with statistically significant differences(all P<0.05). Before treatment,there were no statistically significant differences in the levels of vascularendothelial growth factor (VEGF), creatine kinase (CK), and inhibin A (INH-A)between the two groups (all P>0.05).After treatment, the levels of VEGF, CK, and INH-A in the observation groupwere (83.17±35.31) μg/L, (33.07±10.04) U/L, and (6.86±2.36) μg/L, respectively,which were all lower than those in the control group [(103.50±39.16) μg/L,(38.71±7.31) U/L, and (8.05±2.03) μg/L], with statistically significantdifferences (all P<0.05). Conclusions　Xiaozheng Futongdecoction combined with methotrexate in the treatment of ectopic pregnancy canaccelerate the absorption of mass, promote the blood HCG returning to normal,and reduce the length of stay. The combination of Chinese and chemical drugshas a significant therapeutic effect without adverse reactions, which can bepromoted in clinical practice.