【摘要】 目的探讨甲氨蝶呤单次肌肉注射治疗异位妊娠的疗效 ,并分析其治疗失败的相关因素。方法对比分析成功组及失败组的临床资料 ,包括停经天数、治疗前β HCG值和包块直径、腹痛情况、治疗 3d后β HCG值下降率及包块直径改变情况。结果①成功组停经天数平均为 5 3.4d ,β HCG值平均为1 4 82 .6IU/L ,包块直径平均为 2 .85cm。失败组停经天数平均为 6 2 .3d ,β HCG值平均为 6 6 6 1 .0IU/L ,包块直径平均为 4 .0 7cm。②成功组有 1 4 .3%的病人停经天数≥ 6 0d ,1 1 .4 %的病人血 β HCG值≥ 4 0 0 0IU/L ,治疗 3d后 β HCG值下降率≤ 1 5 %的为 1 4 .3% ,包块直径增加≥ 2 5 %的为 7.9%。而失败组各数值分别为4 0 .0 %、80 .0 %、6 0 .0 %、4 0 .0 %。结论①甲氨蝶呤是一种有效的治疗早期异位妊娠的药物 ;②治疗前的 β HCG值、治疗 3d后β HCG值下降率及包块直径改变情况与治疗失败关系极大 ;③存在胎心搏动并非为异位妊娠药物治疗的禁忌证更多还原

【Abstract】 ObjectivesTo evaluate the therapeutic efficacy and failure factors in single dose methotrexate intramuscular injection for treatment of ectopic pregnancy.MethodsThe clinical data of seventy successfully treated cases and ten failed cases were analyzed comparatively,including the duration of menoschesis,serum b HCG level,diameter of adnexa mass and abdominal pain before treatment as well as the decline rate of serum b HCG level and change of mass diameter 3 days after treatment.ResultsIn succeeded group, the average duration of menoschesis,the mean level of serum HCG and average diameter of adnexa mass were 53.4 days(14.3% of patients ≤60 days),1 482.6 IU/L(11.4% of patients ≥4 000 IU/L) and 2.85cm (7.9% of patients showed increase of mass diameter≥25%),respectively;whereas in failed group,these three corresponding figures were 62.3 days (40.0% of patients≤60 days),6661,0IU/L (80.0% of patients ≥4 000 IU/L) and 4.07cm (40.0% of patients showed increase of mass diameter≥25%),respectively.Three days after treatment, 14.3% of patients in succeeded group revealed a decline rate of serum b HCG level≤15%;while 60.0% of patients in failed group revealed a similar decline rate.Conclusion①Methotrexate is an efficacious drug for treating ectopic pregnancy in its early stage; ②The serum HCG level before treatment,its decline rate and the change of adnexa mass diameter in 3 days after treatment are closely related with the therapy failure;③Presence of fetus heart beating is not a contraindication for drug treatment of ectopic pregnancy.更多还原