益肾促排卵汤联合HCG对排卵障碍性不孕患者刺激周期干预的临床研究

发布时间：2018-01-22 12:26

  本文关键词： 益肾促排卵汤 排卵障碍性不孕 刺激周期　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究采用益肾促排卵汤联合人绒毛膜促性腺激素(HCG)对排卵障碍性不孕患者刺激周期进行干预,观察该法的临床疗效,探讨其可能的作用机制,为中西医结合治疗排卵障碍性不孕提供临床参考,为治疗排卵障碍性不孕症提供新的思路和方法。方法:95例排卵障碍性不孕患者,符合纳入标准,按随机、对照的原则分为治疗组(益肾促排卵汤+HCG组,32例)、对照组1(单纯HCG组,31例)、对照组2(血府逐瘀口服液+HCG组,32例),三组均于经周第5天起口服来曲唑(LE,2.5mg/d)5天,同时于周期第5天起服用滋阴奠基汤,B超监测卵泡发育,酌情辅以尿促性素(HMG)促进优势卵泡发育成熟,当卵泡直径≥16mm时,给予相应干预措施;B超确认排卵后口服健黄助孕汤,若月经来潮或妊娠停用。比较三组卵泡质量及优势卵泡排出情况、未破裂卵泡黄素化综合征(LUFS)发生率、临床妊娠率、流产率、卵巢动脉血流、子宫内膜厚度、中医临床症候评分,并探讨益肾促排卵汤对排卵障碍的简要作用机制。结果:①治疗组排卵率76.25%,LUFS发生率13.75%;对照组1排卵率49.41%,LUFS发生率29.41%;对照组2排卵率65.0%,LUFS发生率20.0%。治疗组与对照组1在排卵率、LUFS发生率上差异有统计学意义(P0.05),治疗组与对照组2、对照组1与对照组2在排卵率、LUFS发生率上差异无统计学意义(P0.05)。②治疗组妊娠14例,流产1例,妊娠率46.7%;对照组1妊娠6例,流产1例,妊娠率20%;对照组2妊娠7例,流产1例,妊娠率24.1%,三组妊娠率差异无统计学意义(P0.05),可能与样本量过少有关。三组在流产率上差异无统计学意义(P0.05)。③治疗组与对照组1、对照组2在治疗后的单卵泡发育率分别为63.75%、56.47%、56.25%(P0.05);治疗组与对照组1、对照组2卵泡质量在治疗后差异有统计学意义(P0.05),对照组1与对照组2在治疗后差异无统计学意义(P0.05)。④治疗组与对照组1、对照组2卵巢基质动脉血流的PI、RI、S/D值在治疗前差异无统计学意义(P0.05),治疗后差异有统计学意义(P0.05)。⑤治疗组与对照组1、对照组2排卵日的子宫内膜厚度分别为9.19±0.68mm、8.57±0.50mm、8.49±0.55mm,差异有统计学意义(P0.05)。经两两对照,治疗组与对照组1、对照组2的差异有统计学意义(P0.05)。⑥在综合疗效方面,治疗组18例痊愈,7例显效,3例有效,2例无效,总有效率93.3%;对照组110例痊愈,7例显效,6例有效,7例无效,总有效率76.7%;对照组2 15例痊愈,7例显效,3例有效,4例无效,总有效率86.2%。治疗组总有效率高于对照组1和对照组2,但差异无统计学意义(P0.05),考虑与样本量小有关。⑦三组病例治疗前、治疗后中医症候积分的比较无统计学意义(P0.05),治疗前后的中医症候积分对比有统计学意义(P0.05)。治疗组与对照组的中医临床症状均获得明显改善,有效率达80%以上。结论:在"补肾活血,化瘀通络"的原则下,抓住"的候期"这一气血氤氲时期,运用益肾促排卵汤联合HCG对排卵障碍性不孕刺激周期进行干预,可明显提高排卵率,降低LUFS发生率,并提高卵泡的质量,改善卵巢动脉血流,促进优质卵泡发育成熟及排出,促进子宫内膜的增长,从而获得满意的妊娠率。补肾活血中药亦可通过调节机体阴阳状态平衡,使气血通畅,脏腑协调,从而改善中医临床症状。
[Abstract]:Objective: To study the tonifying kidney and promoting ovulation decoction combined with human chorionic gonadotropin (HCG) intervention on anovulatory infertility patients stimulation cycle, observe the clinical curative effect, to explore its possible mechanism, provide reference for clinical treatment of anovulatory infertility for traditional Chinese medicine and Western medicine, to provide new ideas and methods for the treatment of anovulatory infertility. Methods: 95 cases of anovulatory infertility patients, met the inclusion criteria, were randomly divided into treatment and control group (Yishen Decoction for ovulation induction in group +HCG, 32 cases) and control group (1 HCG group, 31 cases), control group 2 (blood stasis oral liquid group +HCG, 32 cases), three groups were in the week fifth day oral letrozole (LE, 2.5mg/d) for 5 days, at the same time in the period of fifth days taking Ziyin based decoction, ultrasound monitoring of follicular development, as appropriate, with Menotropins (HMG) to promote the dominant follicle maturation when follicle the diameter is not less than 16mm, to Give the corresponding intervention measures; ultrasound confirmed after ovulation, oral health yellow Zhuyun decoction, if menstruation or pregnancy disabled. The quality of the follicle and advantages of the three groups ovulation, luteinized unruptured follicle syndrome (LUFS) incidence rate, clinical pregnancy rate, abortion rate, ovarian artery blood flow, endometrial thickness, clinical score TCM syndrome, and to explore the tonifying kidney and promoting ovulation decoction on ovulation disorders brief mechanism. Results: the treatment group ovulation rate was 76.25%, the incidence rate of LUFS was 13.75%; the control group of 1 ovulation rate was 49.41%, the incidence rate of LUFS was 29.41%; the control group of 2 ovulation rate was 65%, the incidence rate of LUFS in 20.0%. treatment group and control group 1 in ovulation rate LUFS, there was a significant difference (P0.05), the treatment group and the control group 2, control group 1 and control group 2 in the ovulation rate, LUFS incidence rate had no significant difference (P0.05). The treatment group of 14 cases of pregnancy, abortion in 1 cases, the pregnancy rate was 46.7%; the control group of 1 pregnant women 6渚，

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