紫草合剂辅助米非司酮治疗输卵管妊娠的临床研究(摘要)

【作者】 唐玉琼； 杨柳； 张丽君； 周忠明； 胡长珍； 李晶晶；

【机构】 湖北中医药大学； 湖北省中医院；

【摘要】 异位妊娠是指受精卵在子宫腔以外的任何部位着床。常根据着床部位不同,分为输卵管妊娠、卵巢妊娠、腹腔妊娠、宫颈妊娠及子宫残角妊娠,其中输卵管妊娠最为常见。异位妊娠是妇产科常见急腹症之一,当发生破裂或流产时,可造成急性腹腔内出血,危及生命。目前仍以手术治疗为主,但对于有生育要求的患者来说,保守治疗意义重大。随着诊疗技术水平的提高,血β-HCG监测技术和高分辨率阴式B超的普遍应用,异位妊娠的早期诊断及发生严重内出血之前的诊断,为保守治疗异位妊娠争取了宝贵时间。目的:将紫草合剂辅助米非司酮治疗输卵管妊娠与单独运用米非司酮治疗该病进行比较,得出紫草合剂联合米非司酮组不论从总体疗效、血β-HCG在用药后3、7、14天时的下降程度、盆腔包块吸收时间等都优于单独使用米非司酮组的结论。方法:将45例患者随机分成2组,其中治疗组25例,选用紫草合剂联合米非司酮:对照组20例,单用米非司酮。治疗组于当日晨一次性凉开水送服米非司酮150mg,服药前后2小时禁食水。病情稳定者服药后3天测血HCG,如下降不明显或无下降者依照前法再次服用150mg米非司酮。在第一次服米非司酮时即每日加服中药紫草合剂并随症加减,1日1剂,1剂3次,7天为一个疗程,共2个疗程。治疗过程监测病人HCG值<1000mIU/ml,B超监测异位妊娠包块缩小时给予紫草合剂中药药渣局部热敷。对照组仅按上述方法服用米非司酮1或2次。最后对两组总体疗效、血β-HCG下降的程度、盆腔包块吸收的时间进行对比。结果:(1)两组有效率比较有统计学差异(P<0.05);(2)治疗组用药后3、7、14天的血β-HCG值与对照组在用药后3、7、14天血β-HCG分别比较均有显著性差异(P<0.05)。(3)治疗组和对照组盆腔包块完全吸收的时间对比有显著性差异。结论:米非司酮通过较强的抗孕酮作用与中药紫草合剂联合使用,可以迅速杀胚、促进血β-HCG的下降、加快异位妊娠包块缩小速度、减轻临床腹痛症状,是一种较好的保守治疗异位妊娠的方法。更多还原

【Abstract】 Where the fertilized eggs in any other part of the uterine cavity implantation are collectively referred to as ectopic pregnancy,it is called ectopic pregnancy.According to the implantation site,with tubal pregnancy ovarian pregnancy,abdominal pregnancy,cervical pregnancy and uterine horn pregnancy,ectopic pregnancy with tubal pregnancy,the most common,accounting for more than 90%.Ectopic pregnancy is a common gynecologic acute abdomen,when ruptured ectopic pregnancy or abortion,can cause acute intra-abdominal hemorrhage,and even endanger the lives of patients.While the modern operation in treatment of multiple take salpingectomy,making conception probability decreased by half,but patients often need to preserve reproductive function,so the conservative treatment for ectopic pregnancy has certain advantages.In view of the current development of medical technology,such as serum beta- HCG monitoring technology and high resolution transvaginal B ultrasound universal application,make early diagnosis of ectopic pregnancy and the occurrence of severe internal bleeding before they can be diagnosed,and can receive timely treatment,so as to the conservative treatment of ectopic pregnancy for a time.Objective:Lithospermum mixture of mifepristone treatment of tubal pregnancy and the use of mifepristone treatment alone to compare the obtained the Lithospermum mixture combined with mifepristone group,whether from the overall efficacy of serum 0-HCG after administration,7,14 days decreased the degree of pelvic mass absorption time,the number of segments of inpatient abdominal pain NRS is better than separate mifepristone.Methods:The clinical collection of 45 patients divided into two groups,treatment group,25 cases,the choice of shikonin mixture combined with mifepristone,the first use of mifepristone 150 mg once the cold water delivery service on the same day morning medication before and after 2 hours of fasting water.3 days in stable patients after taking the measurement of blood HCG,such as the decline is not obvious or no decrease,plus clothing 150 mg mifepristone medication the same way.During this period,daily doses of Chinese medicine shikonin mixture and subtraction with the disease,one day,three times a day,warm clothes,7 days a course.A total of 2 treatment.In this process,when the patient HCG values <1000mIU/ml reduced mass,B ultrasonic monitoring to give the local heat of the Lithospermum mixture of Chinese medicine residue.Control group,20 cases of mifepristone only by the above method.Overall efficacy of the two groups,the serum β-HCG decreased absorption of the degree of pelvic mass,the various stages of hospitalized patients with abdominal pain NRS,the number of segments compared.ResuIts:(1) two groups have significant difference(P < 0.05);(2) the treatment group and control group after administration of 3,7,14 days of blood beta- HCG,respectively There was a significant difference(P <0.05).(3) the two groups compared,a significant difference.更多还原