宋曼莉+赵志伟+龚江红+许燕萍

[摘要] 目的 探讨临床应用甲氨喋呤治疗异位妊娠快捷、有效的用药方法。方法 随机选取2015年1月—2016年6月该院收治的100例临床确诊的初次异位妊娠患者，随机分为两组，A组给予甲氨喋呤连续5 d，1次/d肌内注射，B组给予较高浓度一次性肌注甲氨喋呤冲击治疗，观察并比较两组患者的病情变化以及出现的药物不良反应情况。 结果 两组患者在治疗两周后，依据A、B两组患者血β-HCG检测水平降低情况及超声检查孕囊变化为治愈指标，A组治愈率为76.7%，B组治愈率为93.3%，B组治愈率明显高于A组，且两组间比较差异有统计学意义（P <0.05）。A、B两组患者药物不良反应发生率分别为6.7%和10.0%，差异无统计学意义（P >0.05）。结论 临床应用甲氨喋呤治疗异位妊娠，较高浓度一次性肌注冲击疗法较肌内注射持续给药方法更快捷，更有效，值得临床推广。

[关键词] 异位妊娠；甲氨喋呤；冲击治疗；持续给药

[中图分类号] R714 [文献标识码] A [文章编号] 1674-0742（2017）01（c）-0137-03

Clinical Comparison of Methopterin in Treatment of Ectopic Gestation

SONG Man-li1， ZHAO Zhi-wei2，GONG Jiang-hong3，XU Yan-ping3

1.Department of Obstetrics， Haicang Hospital of Xiamen， Xiamen， Fujian Province， 361026 China；2.Department of clinical Laboratory， Haicang Hospital of Xiamen， Xiamen， Fujian Province， 361026 China；3.Department of Obstetrics and Gynecology，Haicang Hospital of Xiamen，Xiamen，Fujian Province，361026 China

[Abstract] Objective To study the rapid and effective medication method of methopterin in treatment of ectopic gestation. Methods 100 cases of patients with initial ectopic gestation admitted and treated in our hospital from January 2015 to June 2016 were random selected and randomly divided into two groups， the group A adopted the intramuscular injection of methopterin for 5 consecutive days once a day， the group B adopted the one-time high concentration intramuscular pulse treatment of methopterin， and the changes of disease and adverse reactions of drugs of the two groups were observed and compared. Results After 2-week treatment， the cure rate in the group B was obviously higher than that in the group A（6.7% vs 10.0%）， and the difference had statistical significance（P <0.05）， and the incidence rate of adverse reactions of drugs in the group A and group B was respectively 6.7% and 10.0%， but the difference had no statistical significance（P >0.05）. Conclusion One-time high concentration intramuscular pulse treatment of methopterin is more rapid and effective than the intramuscular injection continuous administration method， which is worth clinical promotion.

[Key words] Ectopic gestation； Methopterin； Pulse therapy； Continuous administration

異位妊娠是受精卵在子宫腔正常位置以外着床发育的异常妊娠过程，是最常见的妇产科急腹症，约占80%以上，易与外科急腹症相混淆而延误诊治，且患者近年来逐渐趋向年轻化[1]。随着医学的发展，血β-人绒毛膜促性腺激素（human chorionic gonadotropin，β-HCG）检测和超声检查等技术在临床上得到广泛应用，异位妊娠诊断水平不断得到提高。在异位妊娠治疗上，甲氨喋呤的应用，免去了患者手术治疗的痛苦和风险，目前甲氨喋呤保守性治疗异位妊娠已成为患者的首选[2]。该文对厦门海沧医院妇产科2015年1月—2016年6月收治的120例初次异位妊娠临床确诊患者进行随机分组，分别给予甲氨喋呤5 d肌内注射持续给药和较高浓度一次性肌注冲击治疗，并对两组患者的治愈率和药物不良反应发生率进行统计和分析，以此评价两种方法的治疗效果，现报道如下。……