天花粉蛋白治疗异位妊娠的临床应用及不良反应分析  

Clinical application of trichosanthin in the treatment of ectopic pregnancy and analysis of its adverse reactions

作　　者：戴良图[1] 张华[1] 王晨曦[1] 黄玲[1] 李扬[1] 朱梅娟[1] 

机构地区：[1]解放军第四一一医院妇产科,上海200081

出　　处：《海军医学杂志》2013年第5期321-324,共4页Journal of Navy Medicine

摘　　要：目的探讨天花粉蛋白治疗异位妊娠的临床应用价值及不良反应。方法选择124例异位妊娠未破裂型患者,分别采用肌肉注射、宫颈注射和孕囊注射天花粉蛋白1.2～2.4 mg,观察其疗效和不良反应。结果 124例均保守治疗成功,有18例辅以甲氨蝶呤肌肉注射或天花粉蛋白介入治疗,介入治疗后3～5 d大部分患者血人绒毛膜促性腺激素β亚单位(β-hCG)下降60%以上。不良反应:44例患者出现发热,四肢酸痛,注射部位红肿、疼痛、皮疹;19例治疗后24 h内出现腹痛加剧伴腹泻,个别出现呕吐,腹痛为阵发性胀痛或绞痛;15例出现腹部肌紧张、压痛、反跳痛,应与异位妊娠破裂鉴别;15例患者生命体征平稳,腹部叩诊移动性浊音阴性,发热时脉搏快但有力,床边B超检查盆腔、腹腔未见积液,予以止泻、解痉、调节肠功能等处理,24～48 h症状减轻;3例出现胸闷、呼吸困难,吸氧后缓解。结论天花粉蛋白治疗血β-hCG值较高但胎膜未破裂的异位妊娠效果良好,但不良反应较大,应采取预防措施并给予对症治疗。Objective To investigate the clinical value and adverse effects of trichosanthin in the treatment of ectopic pregnancy. Methods One hundred and twenty-four cases of unruptured ectopic pregnancy were chosen in our study, and they received muscular, intracervical and pregnant sac injection of 1.2～2.4 mg trichosanthin. Then, therapeutic effects and adverse reactions were observed closely. Results Conservative treatment in all the 124 cases was successful. Of all the cases, 18 received either accessory muscular methotrexate injection or trichosanthin intervention treatment. Three to five days after intervention treatment, the level of blood β-HCG in most patients decreased by over 60%. Adverse reactions occurred in 44 cases： high fever, pain in limbs, swelling in injection sites and skin rash. Twenty-four hours after treatment, 19 cases experienced severer abdominal pain coupled with diarrhea, and few cases had vomiting, with abdominal pain and sporadic swelling pain or gripping pain. Fifteen cases experienced tenderness, rebound tenderness, which should be discriminated from ectopic pregnancy disruption. In another 15 cases, vital signs were stable. Percussion showed that there was negative moving dull sound in the abdomen. In case of fever, pulse was fast, but forceful. Bedside, ultrasonography indicated that dropsy was absent in the pelvic and abdominal cavity. Treatment of diarrhea, spasm and restoration of intestinal function were given according to patients＇ conditions. Three cases displayed chest distress and dyspnea, but symptoms soon released following oxygen breathing. Conclusion Trichosanthin could produced good effect in the treatment of unruptured ectopic pregnancy cases with high level of blood β-HCG, however, serious adverse reactions might occur. For this reason, preventive measures should be taken and expectant treatment be applied accordingly.

关 键 词：异位妊娠 不良反应 天花粉蛋白 

分 类 号：R714.22[医药卫生—妇产科学]