CAJ | 학술논문

目的：探讨天花粉蛋白治疗剖宫产子宫切口瘢痕妊娠的临床应用价值及不良反应。方法21例剖宫产子宫切口瘢痕妊娠者，在患者知情同意下，根据注射部位不同分成肌肉注射组（肌肉组，10例）和宫颈注射组（宫颈组，11例），皮试阴性后注射天花粉蛋白1．8～3．6 mg治疗，观察治疗后7 d血中人绒毛膜促性腺激素（β-HCG）下降程度和不良反应。结果2组均治疗成功。治疗后7 d，肌肉组有8例β-HCG下降70％以上，2例β-HCG下降幅度＜50％，其中1例给予第2次天花粉蛋白肌肉注射，1例辅以甲氨蝶呤治疗。肌肉组有10例出现发热，四肢酸痛，注射部位红肿疼痛、皮疹；1例出现胸闷、呼吸困难，给予抗过敏和吸氧后缓解。宫颈组天花粉蛋白治疗后7 dβ-HCG全部下降70％以上，有4例出现发热、四肢酸痛，但症状比肌肉组轻。结论天花粉蛋白治疗剖宫产子宫切口瘢痕妊娠疗效较好，但存在一定的不良反应，肌肉注射的不良反应较大，宫颈注射的不良反应相对较小。无论采取何种注射方法，给药后均应严密观察不良反应，给予对症处理。
목적：탐토천화분단백치료부궁산자궁절구반흔임신적림상응용개치급불량반응。방법21례부궁산자궁절구반흔임신자，재환자지정동의하，근거주사부위불동분성기육주사조（기육조，10례）화궁경주사조（궁경조，11례），피시음성후주사천화분단백1．8～3．6 mg치료，관찰치료후7 d혈중인융모막촉성선격소（β-HCG）하강정도화불량반응。결과2조균치료성공。치료후7 d，기육조유8례β-HCG하강70％이상，2례β-HCG하강폭도＜50％，기중1례급여제2차천화분단백기육주사，1례보이갑안접령치료。기육조유10례출현발열，사지산통，주사부위홍종동통、피진；1례출현흉민、호흡곤난，급여항과민화흡양후완해。궁경조천화분단백치료후7 dβ-HCG전부하강70％이상，유4례출현발열、사지산통，단증상비기육조경。결론천화분단백치료부궁산자궁절구반흔임신료효교호，단존재일정적불량반응，기육주사적불량반응교대，궁경주사적불량반응상대교소。무론채취하충주사방법，급약후균응엄밀관찰불량반응，급여대증처리。
Objective To investigate the clinical value of trichosanthin in the treatment of cesarean scar pregnancy and in-curred adverse reactions.Methods Twenty-one cases of cesarean scar pregnancy were chosen for our study.With the knowledge and consent of the patients and in accordance with different sites of injection, the patients were divided into the muscular injection group (10 cases) and the intracervical injection group (11 cases) .Following negative skin test, the patients respectively received muscular and intracervical trichosanthin injection at a dosage of 1.8-3.6 mg.Seven days after treatment, close observation was made on the decrease of human chorionic gonadotropin (β-HCG) and adverse reactions induced by the drug.Results The patients in the 2 groups all respon-ded quite well to the treatment.After 7 days of treatment, a sharp reduction ofβ-HCG by over 70%was noted in 8 cases of the muscu-lar injection group, and a reduction ofβ-HCG by less than 50%was seen in 2 cases.Of the 2 cases, one had a secondary muscular in-jection and one was supplemented with methotrexate.The patients in the muscular injection group had such adverse reactions as fever, pain in the limbs, swelling and pain in the injection sites and skin rash.One case displayed chest distress and dyspnea, but symptoms were soon relieved following antianaphylactic treatment and oxygen breathing.Seven days after treatment with trichosanthin, the level ofβ-HCG in the patients of the intracervical injection group all dropped by over 70%.Four patients had such symptoms as fever, pain in the limbs, however, symptoms were lighter than those of the muscular injection group.Conclusion Trichosanthin injection seemed to produce good effect on cesarean scar pregnancy, however, adverse reactions might occur in the course of treatment, with muscular injec-tion having severer reactions, and trichosanthin injection having lighter reactions.For this reason, close observation should be made on the adverse reactions, no matter what injections were given, and expectant treatment should be applied accordingly following medication.