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目的:系统比较超声引导的甲氨蝶呤局部注射与非超声引导甲氨蝶呤全身肌肉注射治疗异位妊娠的效果。方法:计算机检索超声引导甲氨蝶呤局部注射对比甲氨蝶呤全身肌肉注射患者随机对照研究,时间截止至2013年12月。由2位研究者独立评价纳入研究的质量并提取数据,统计分析采用RevMan 5.2.7软件进行。结果:纳入13个研究,共1 069例患者。Meta分析结果显示:与对照组相比,B超引导注射能提高治愈率(RR=1.28,95%CI 1.21~1.36,P<0.000 01),减少β-HCG降至正常水平所需时间(MD=-8.30,95%CI-10.85~-5.75,P<0.000 01),能降低肌肉注射所带来的胃肠道反应(RR=0.37,95%CI 0.21~0.65,P=0.000 5)、骨髓抑制(RR=0.42,95%CI 0.20~0.89,P=0.02)、口腔溃疡(RR=0.46,95%CI0.23~0.89,P=0.02)、肝功能异常(RR=0.35,95%CI 0.15~0.82,P=0.01)。结论:相比于甲氨蝶呤的全身肌肉注射,超声引导的局部注射具有疗效高、副作用小等优点,但是低质量的原始研究可能大大降低了证据的可信度,对于此课题还需要更多更科学、更可靠的临床实验去证实和研究。
OBJECTIVE: To systematically compare the effect of ultrasound-guided local injection of methotrexate and non-ultrasound-guided intramuscular injection of methotrexate in the treatment of ectopic pregnancy. METHODS: A randomized, controlled, computer-assisted ultrasound-guided methotrexate-specific intramuscular injection of methotrexate was performed until December 2013. Two investigators independently assessed the quality of the included studies and extracted the data. Statistical analysis was performed using RevMan 5.2.7 software. Results: A total of 1 069 patients were enrolled in 13 studies. Meta-analysis showed that B-guided injection improved the cure rate (RR = 1.28, 95% CI 1.21-1.36, P <0.000 01) and decreased the time required for β-HCG to decrease to normal level = -8.30, 95% CI-10.85 ~ -5.75, P <0.000 01), which could reduce the gastrointestinal reaction caused by intramuscular injection (RR = 0.37, 95% CI 0.21-0.65, P = 0.0005) (RR = 0.46, 95% CI 0.23-0.89, P = 0.02), liver dysfunction (RR = 0.35, 95% CI 0.15 ~ 0.82, P = 0.01). CONCLUSIONS: Ultrasound-guided local injection has the advantages of high efficacy and small side effects compared to general intramuscular injection of methotrexate, but low-quality original studies may greatly reduce the credibility of the evidence and require more More scientific, more reliable clinical trials to confirm and research.