mtx胎盘植入保守治疗.docVIP

目的：探讨甲氨蝶呤(MTX)肌肉注射及中药生化汤联合治疗植入性胎盘的疗效。方法：将41例胎盘植入的患者随机分为两组，研究组19例，给予MTX治疗，方法为50mg隔日肌内注射3次，并于注射MTX后12～24 h内加用甲酰四氢叶酸(CF)解毒，同时每天给予中药生化汤(加减)口服;对照组22例，仅采用口服中药生化汤(加减)治疗，两组治疗前血清β-HCG值、宫腔内病灶面积大小均无明显差异，两组均定期复查B超和血清β-HCG水平直至正常。结果：经治疗1周及2周后复查，研究组血清β-HCG值均较前次检查结果明显下降(P0.001),宫腔内残留胎盘组织面积也较前次检查结果明显缩小(P0.001)，与同期对照组血清β-HCG值及宫腔内残留庭盘组织面积相比较，其差异亦有统计学意义(P0.001),而研究组血清β-HCG水平降至正常时间亦较对照组明显缩短(P0.001)。结论 ：MTX肌内注射联合中药生化汤治疗胎盘植入，其效果较单纯应用中药生化汤治疗疗效更佳，可以有效治疗植入性胎盘，最大限度地保留子宫，保留生育功能。 【关键词】? 甲氨蝶呤;生化汤;植入性胎盘;血清β-HCG;产后出血 　　Clinical application of methotrexate connecting biochemistry soup in placenta implantation LI Miao，XU Xiao-feng (Shilong Boai Hospital of Dongguan City，Dongguan 523320，China) 　　Abstract：ObjectiveTo study the effects of methotrexate connecting biochemistry soup for placenta implantation.MethodTotal 41 patients with placenta implantation were randomly divided into the research group(n=19) and the control group(n=22).Subjects of the research group were injected with 50 mg methotrexate (MTX) into muscle every other day.Leucovorin injection was used to prevent harmful effects of MTX in 12～24 hours after MTX injection，and biochemistry soup was taken orally every day.Control subjects were just treated with biochemistry soup.No differences of serum β-HCG level and area of residues of placenta were found between the two groups before treatment.ResultsAfter one or two weeks′ treatment，serum β-HCG level decreased and was lower in the research group than the control group(P0.001). Area of residues of placenta significantly decreased in the research group than the control group (P0.001).Meanwhile，the time of serum β-HCG level decreased to normal level was significantly shorter in the research group than the control group(P0.001).ConclusionMTX injection into muscle connecting biochemistry soup in placenta implantation can retain the uterus to the great extent，also the fertile ability. 　　Key Words:Methotrexate;Biochemistry soup;Placenta implantation;β-HCG;Postpartum hemorrhage 　　植入性胎盘是产科少见但较严重的并发