生化汤联合西药治疗子宫下段切口妊娠疗效分析(1)

http://www.100md.com 2015年6月5日 《中外医疗》 201516

     [摘要] 目的 探讨中药生化汤联合甲氨蝶呤配伍米非司酮对剖宫产切口妊娠的治疗效果。方法 将确诊为剖宫产切口妊娠并选择保守治疗的患者随机分为试验组和对照组各35例。对照组：甲氨蝶呤(MTX)采用分次给药，每1、3、5、7 d肌注50 mg， 2、4、6、8 d给予亚叶酸钙0.1 g静滴解毒。试验组：在应用西药的基础上加用生化汤，比较两组清宫术中出血量、β人绒毛膜促性腺激素(β-HCG)降至正常时间、成功率、住院时间和并发症情况等。 结果 观察组阴道出血量(371.3±158.3)mL、血β-HCG转阴时间(52.1±18.1)d、住院时间(30.1±14.9)d、不良反应率42.9%；对照组分别为(631.6±227.9)mL、(81.6±21.3)d、(51.2±22.1)d、77.1%，两组比较差异有统计学意义(P<0.05)；观察组治疗的成功率71.4%，对照组为65.7%，两组比较差异无统计学意义(P>0.05)。结论 生化汤联合甲氨蝶呤及米非司酮治疗剖宫产切口妊娠效果显著，安全性高，值得临床推广应用。

    [关键词] 剖宫产切口妊娠；生化汤；甲氨蝶呤；米非司酮

    [中图分类号] R4 [文献标识码] A [文章编号] 1674-0742(2015)06(a)-0166-03

    Analysis of Effect of Shenghua Decoction Combined with Methotrexate and Mifepristone in Treating Caesarean Incision Pregnancy

    WANG Feng1， ZHANG Qing-wei1，YU Jiang-hua1， ZHANG Rui-ling2

    1. First Affiliated Hospital of Luohe Medical College， Luohe， Henan Province， 462000 China；2. Second People's Hospital of Luohe City， Luohe， Henan Province， 462000 China

    [Abstract] Objective To explore the effect of shenghua decoction combined with methotrexate and mifepristone in the treatment of caesarean incision pregnancy. Methods Diagnosed patients who voluntarily received conservative treatment were randomly divided into treatment and observation with 35 cases in each group. Control group：-methotrexate (MTX) using fractional dosing， every 1， 3， 5，7 d intramuscular injection of 50mg， 2， 4， 6， 8 d to give intravenous drip of calcium folinate 0.1g detoxification. Observation： in the application of Western medicine based on the addition of shenghua decoction and compare two sets of curettage bleeding， β-human chorionic gonadotropin (β-HCG) to normal time， success rates， length of hospital stay and complications， and so on. Results Vaginal bleeding in the observation group (371.3 ± 158.3) mL and serum β-HCG negative time (52.1 ± 18.1) d， length of hospital stay (30.1 ± 14.9) d， adverse reaction rate is 42. 9%， respectively， in the control group (631.6 ± 227.9) mL， (81.6 ± 21.3) d， (51.2 ± 22.1) d， 77.1%， there was a significant difference between the two groups(P<0.05)； treatment success 71.4% in the observation group， control group was 65.7%， no significant differences between the two groups(P>0.05). Conclusion Shenghua decoction combined with methotrexate and mifepristone in the treatment of caesarean incision in pregnancy is safe and effective， so it is worth spreading.

    [Key words] Caesarean incision pregnancy； Shenghua decoction； Methotrexate； Mifepristone

    近年来，随着我国剖宫产率的增高，子宫下段切口妊娠(caesarean incision pregnancy，CSP)的发生率也呈上升趋势。该病具有很大的潜在危险，若处理不当，很容易发生难以控制的大出血而不得不切除子宫，甚至丧失生命，应引起重视。剖宫产切口妊娠是一种罕见的异位妊娠，临床常因误诊行刮宫引起严重出血、休克而危及生命，治疗关键在于早期诊断、及时处理。随着人们对CSP认识的不断提高，加之阴道彩超、MRI等检查手段的广泛应用，使得绝大多数CSP患者早期即可做出诊断，从而为保守治疗创造了先决条件，明显提升了治疗效果[1]。该院在2005年1月—2013年12月采用中药生化汤配伍甲氨蝶呤和米非司酮治疗切口妊娠取得了良好效果，现报道如下。(王锋等)

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