中医药干预IVF-ET母亲妊娠结局及健康情况分析

发布时间：2018-03-10 08:20

本文选题：中医药干预　切入点：IVF-ET　出处：《山东中医药大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：分析中医药干预体外受精-胚胎移植（In Vitro Fertilization and EmbryoTransfer，IVF-ET）成功分娩母亲妊娠期及分娩和产后并发症的发生率，并与我国自然妊娠流行病学数据比较，为中医药干预IVF-ET安全性提供临床参考。方法：随机抽取2003年1月-2006年1月，2009年6月-2014年1月就诊于山东中医药大学附属医院中西医结合生殖与遗传中心，行中医药干预IVF-ET并成功分娩的不孕症患者为研究对象，共190例。分别建立《中医药干预IVF-ET母亲健康检查表》，登记不孕患者的联系方式、一般情况（包括病历号、年龄、IVF-ET指征、胚胎移植日期等相关信息）及服用中药情况。主要通过电话对成功分娩的患者随访调查，登记两大类信息：1、母亲妊娠期并发症，如：卵巢过度刺激综合征（OvarianHyperstimulation Syndrome，OHSS）、妊娠期贫血、异位妊娠（Ectopic Pregnancy，EP）、妊娠期高血压疾病（Pregnaney Induced Hypertension Syndrome，PIH）、妊娠期糖尿病（Gestational diabetes mellitus，GDM）、妊娠期肝内胆汁淤积症、前置胎盘、胎盘早剥、胎膜早破、羊水过少、羊水过多、脐带绕颈、耻骨联合分离等并发症；2、分娩及产后并发症：分娩方式、分娩孕周、产后出血、产后月经改变等情况。对收集到的数据进行统计学处理，并与我国自然妊娠流行病学数据进行比较分析。结果： 1.一般情况：单胎146例（76.84%），双胎44例（23.15%），双胎妊娠率符合IVF-ET的双胎出生率（20%-30%），但高于根据自然妊娠Hellin多胎妊娠计算公式（多胎发生率为1：80n-1）所计算的结果（双胎率1.25%）。 2.母亲妊娠期并发症：中医药干预IVF-ET母亲宫内合并宫外妊娠的发生率为0.53%，低于IVF-ET的流行病学数据（2.1%-8.6%），但高于自然妊娠的流行病学数据（1:3889-1:30000）。中医药干预IVF-ET母亲妊娠期合并OHSS、PIH的发病率低于流行病学数据，其中单胎与双胎之间PIH发病率的差异无统计学意义（P0.05）。中医药干预IVF-ET母亲与自然妊娠母亲之间的妊娠期贫血、胎膜早破、脐带绕颈发病率的差异有统计学意义（P0.05）。 3.分娩及产后并发症：分娩方式中剖宫产171例（90%），早产30例（15.78%）。其中不同胎数之间剖宫产率的差异无统计学意义（P0.05）。不同胎数之间早产率的差异有统计学意义（P0.05），双胎妊娠的早产率要高于单胎（0R0.107，95%CI0.046-0.252）。结论： 1.中医药干预IVF-ET助孕患者成功分娩的子代双胎率符合IVF-ET双胎出生率的流行病学数据，但高于我国自然妊娠流行病学数据。 2.中医药干预IVF-ET母亲宫内合并宫外妊娠的发生率低于IVF-ET的流行病学数据资料但高于自然妊娠流行病学资料。其中中医药干预IVF-ET母亲妊娠期合并OHSS、PIH、妊娠期贫血、胎膜早破、脐带绕颈的发病率低于自然妊娠流行病学数据。 3.中医药干预IVF-ET母亲分娩的剖宫产率、早产率明显高于我国自然妊娠流行病学数据，，其中早产率升高与双胎妊娠率较高有相关性。
[Abstract]:Objective: to analyze the incidence of pregnancy, delivery and postpartum complications in Vitro Fertilization and Embryo transfer (IVF-ETT) intervention of traditional Chinese medicine (TCM), and compare with the epidemiological data of natural pregnancy in China. To provide clinical reference for Chinese medicine to interfere with the safety of IVF-ET. Methods: from January 2003 to January 2006, from June 2009 to June 2009, we randomly selected the infertile patients who were treated with traditional Chinese medicine (TCM) intervention in IVF-ET and delivered successfully at the Center for Reproductive and genetic Integration of traditional Chinese Medicine and Western Medicine, affiliated Hospital of Shandong University of traditional Chinese Medicine (Shandong University of traditional Chinese Medicine). A total of 190 cases were selected to establish the "Maternal Health examination form of intervention of traditional Chinese Medicine (TCM)", to register the contact information of infertile patients, general information (including medical record number, age and IVF-ET indication), Follow up the successful delivery patients by telephone, register two kinds of information: 1, pregnancy complications, such as ovarian hyperstimulation syndrome, ovarian hyperstimulation Syndrome OHSS, gestational anemia, Ectopic Pregnancy#en0#, Pregnaney Induced Hypertension SyndromeP, gestational diabetes mellitus Gestational diabetes mellitusus GDMN, intrahepatic cholestasis of pregnancy, placenta previa, placental abruption, premature rupture of membranes, oligohydramnios, amniotic fluid, amniotic fluid, umbilical cord around neck, Complications such as symphysis pubis separation, parturition and postpartum complications: mode of delivery, gestational weeks of delivery, postpartum hemorrhage, changes in postpartum menstruation, etc. And compared with the epidemiological data of natural pregnancy in China. Results:. 1. General situation: one hundred and forty-six cases with single pregnancy and 44 cases with twin pregnancy were 23.150.The twin pregnancy rate was in line with the twin birth rate of IVF-ET, but it was higher than that calculated according to the formula of Hellin multiple pregnancy of natural pregnancy (1: 80n-1) (the twin pregnancy rate was 1.25%). 2. Complications of pregnancy: the incidence of intrauterine and extrauterine pregnancy in IVF-ET mothers with TCM intervention was 0.53, which was lower than that of IVF-ET epidemiology data (2.1-8.6), but higher than that of natural pregnancy (1.3889-1: 300000.Chinese medicine interfered with pregnancy complicating IVF-ET mothers' pregnancy). The incidence of OHSS PIH was lower than that of epidemiology. There was no significant difference in the incidence of PIH between single and twin children. There was a significant difference in the incidence of pregnancy anemia, premature rupture of membranes and umbilical cord around neck between IVF-ET mothers and natural pregnant mothers by traditional Chinese medicine (TCM). 3. Delivery and postpartum complications: 171 cases of cesarean section and 30 cases of premature delivery were involved in the mode of delivery. There was no significant difference in cesarean section rate among different number of births (P 0.05). The preterm rate of pregnancy was higher than that of single pregnancy. Conclusion:. 1. The rate of twin twins in the successful delivery of IVF-ET assisted pregnancy patients with traditional Chinese medicine was in line with the epidemiological data of the birth rate of IVF-ET twins, but higher than that of natural pregnancy in China. 2. The incidence of intrauterine pregnancy associated with ectopic pregnancy in IVF-ET mothers was lower than that of IVF-ET, but higher than that of natural pregnancy. Among them, Chinese medicine intervention in IVF-ET mother pregnancy with OHSS PIH, gestational anemia, premature rupture of membranes. The incidence of umbilical cord around neck was lower than that of natural pregnancy. 3. The rate of preterm delivery of IVF-ET mothers was significantly higher than that of natural pregnancy in China, and there was a correlation between the increase of preterm delivery rate and the rate of twin pregnancy.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.8

【参考文献】