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目的:观察甲氨蝶呤(MTX)联合米非司酮对输卵管妊娠总的疗效及不同孕酮水平输卵管妊娠的疗效。方法:将符合保守治疗条件的输卵管妊娠患者67例随机分为2组,对照组33例MTX(50mg/m2)单次肌内注射,研究组34例MTX(50mg/m2)单次肌内注射,第二天口服米非司酮200mg连续3天,两组均定期监测血β-HCG水平,B超监测包块缩小情况。根据孕酮值再将两组分为甲、乙两组比较疗效。结果:研究组治愈率91.2%,对照组治愈率84.8%,但无统计学意义(P>0.05),研究组血β-HCG转阴时间、包块缩小率均优于对照组,差异显著。甲乙两组比较,血孕酮<31.7nmol/L时,两组治愈率无显著性差异(93.3%,92.9%),血孕酮≥31.7nmol/L时,研究组与对照组治愈率有显著差异(95%,77.8%)。结论:对血β-HCG<3000U/L,血孕酮<31.7nmol/L的输卵管妊娠单用MTX(50mg/m2)单次肌内注射疗程简单、效果好、副反应少,对血β-HCG<3000U/L,血孕酮≥31.7nmol/L的输卵管妊娠应选用MTX和米非司酮联用方案。
Objective: To observe the curative effect of methotrexate (MTX) and mifepristone on tubal pregnancy and tubal pregnancy at different levels of progesterone. Methods: Sixty-seven patients with tubal pregnancy who met the conservative treatment conditions were randomly divided into two groups. The control group consisted of 33 MTX (50mg / m2) single intramuscular injection. The study group received intramuscular injection of 34 MTX (50mg / m2) , The next day oral mifepristone 200mg for 3 days, both groups are regular monitoring of serum β-HCG levels, B-ultrasound monitoring of mass reduction. According to the progesterone value, the two groups were divided into A and B groups for comparative efficacy. Results: The cure rate of study group was 91.2%, while that of control group was 84.8%, but there was no statistical significance (P> 0.05). The blood β-HCG negative conversion time and the mass reduction rate of the study group were all better than the control group. There was no significant difference (93.3%, 92.9%) between the two groups when blood progesterone was less than 31.7nmol / L in group A and B. The cure rate was significantly higher in study group and control group when blood progesterone was more than or equal to 31.7nmol / L Differences (95%, 77.8%). Conclusion: Single intramuscular injection of MTX (50mg / m2) alone for tubal pregnancy with blood β-HCG <3000U / L and blood progesterone <31.7nmol / L is simple, effective and has few side effects. HCG <3000U / L, blood progesterone ≥ 31.7nmol / L tubal pregnancy should be used MTX and mifepristone combination program.