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目的观察不同剂量甲氨蝶呤(MTX)肌肉注射与介入治疗异位妊娠的临床疗效。方法依据血清β-hCG测值及妊娠囊大小对132例临床和超声检查疑诊为异位妊娠的患者进行分组治疗。保守治疗组76例,患者血清β-hCG平均值(19368±21423)IU/L,妊娠囊平均直径(31.83±19.06)mm,采用单次肌肉注射MTX50mg进行治疗。介入治疗组56例,依据患者血清β-hCG测值高低(52872±56303)IU/L及妊娠囊大小(44.00±21.80)mm,超声引导下妊娠囊穿刺注射MTX50mg(25例)、75mg(18例)及100mg(13例)介入治疗。治疗后第7天分别对两组患者行血清β-hCG检测,超声观察妊娠囊大小及形态改变,统计患者治疗有效率及副反应发生率。结果治疗后第7天,保守治疗组46例患者血清β-hCG值明显下降平均为(772±242)IU/L,妊娠囊缩小平均直径为(5.80±11.70)mm,治疗有效率为60.53%(46/76),副反应发生率为32.89%(25/76),表现为口腔溃疡、恶心、呕吐等症状。介入治疗组52例患者血清β-hCG值明显下降平均为(3378±54806)IU/L,妊娠囊缩小直径平均为(13.55±5.79)mm,治疗有效率为92.86%(52/56),患者均无明显副反应发生。结论依据患者血清β-hCG测值及妊娠囊大小,适时调整药物剂量,在超声引导下对异位妊娠患者妊娠囊定量注射MTX介入治疗较肌肉注射MTX治疗疗效好、副作用小,有重要临床意义。
Objective To observe the clinical effects of different doses of methotrexate (MTX) intramuscular injection and interventional treatment of ectopic pregnancy. Methods Based on the serum β-hCG and gestational sac size, 132 patients with suspected ectopic pregnancy undergoing clinical and ultrasonographic examinations were divided into groups. Conservative treatment group 76 patients, the average serum β-hCG (19368 ± 21423) IU / L, mean gestational sac diameter (31.83 ± 19.06) mm, a single intramuscular injection of MTX50mg for treatment. Fifty-six patients were involved in the interventional therapy group. According to the serum β-hCG level (52872 ± 56303) IU / L and gestational sac size (44.00 ± 21.80) mm, MTX50mg (25 cases) and 75mg Cases) and 100mg (13 cases) interventional therapy. On the 7th day after treatment, the serum β-hCG levels were measured in both groups. The size and shape of gestational sac were observed with ultrasound. The treatment efficiency and incidence of side effects were calculated. Results On the 7th day after treatment, the serum β-hCG decreased significantly (772 ± 242) IU / L in 46 patients in the conservative treatment group and 5.80 ± 11.70 mm in the pregnant pregnancy group. The effective rate of treatment was 60.53% (46/76), the incidence of side effects was 32.89% (25/76), manifested as oral ulcers, nausea, vomiting and other symptoms. Serum β-hCG decreased significantly (3378 ± 54806) IU / L on average in 52 cases of interventional therapy group, mean reduction of diameter of gestational sac was (13.55 ± 5.79) mm, and effective rate of treatment was 92.86% (52/56) No obvious side effects occurred. Conclusions According to the serum β-hCG measurement and gestational sac size, the dosage of MTX is adjusted timely. It is of great clinical significance that the MTX intervention in pregnant women with ectopic pregnancy is more effective than intramuscular injection of MTX under the guidance of ultrasound. .