补肾祛瘀法防治GnRH-a致血管舒缩综合征的临床研究

发布时间：2018-05-16 11:13

本文选题：补肾祛瘀法 + 子宫内膜异位症　；参考：《福建中医药大学》2017年硕士论文

【摘要】：目的观察补肾祛瘀法对子宫内膜异位症腹腔镜术后证属肾虚血瘀证患者的治疗作用及其防治术后应用GnRH-a致血管舒缩综合征的临床疗效,为其临床应用提供科学依据,增加患者对GnRH-a的耐受性,提高其治疗效果,减少内异症腹腔镜术后应用GnRH-a引起的血管舒缩综合征的发生。方法选取2015年7月至2016年12月在福建中医药大学附属人民医院妇科病房住院的腹腔镜术后确诊为EMT、应用GnRH-a治疗、证属肾虚血瘀证的患者60例,随机分为实验组、对照组,每组各30例,实验组采用中药治疗,选方补肾祛瘀方,术后从注射醋酸亮丙瑞林后第1天起服药,每日一剂,一剂2包,早、晚各1包,餐后半小时冲服,每疗程口服21天,共治疗三个疗程。对照组皮下注射醋酸亮丙瑞林,共三针,不予其他处理。若患者血管舒缩综合征症状明显,予谷维素口服,一次1片,一日3次。于注射第3针后的28天进行疗效评估,观察两组患者治疗前后肾、血瘀积分及分级的改变情况,观察两组患者血管舒缩综合征的发生情况及E2、FSH的变化,并对数据进行统计学分析。结果1.治疗前两组肾、血瘀积分及分级无显著性差异(P0.05),治疗后实验组肾积分及分级较治疗前降低(P0.05),对照组肾积分及分级较治疗前升高(P0.05)。治疗后两组血瘀积分及分级均较治疗前降低(P0.05),且实验组血瘀积分及分级较对照组低(P0.05)。2.治疗前两组E2、FSH水平无显著性差异(P0.05),治疗后两组E2、FSH水平均较治疗前下降(P0.05),但两组治疗后E2、FSH水平差异无统计学意义(P0.05)。3.治疗前两组患者均无血管舒缩综合征的发生,治疗后实验组出现阵发性烘热、潮红、汗出、心悸的例数及血管舒缩综合征得分均较对照组低,差异有统计学意义(P0.05)。结论1.腹腔镜术后确诊为EMT、证属肾虚血瘀证的患者,应用GnRH-a治疗,易加剧其肾虚程度,患者术中局部血瘀程度改善,但手术血络损伤,必然疲血未净,补肾祛瘀法可通过降低肾积分及分级,改善血瘀积分及分级起到治疗作用。2.在GnRH-a的作用下患者体内的E2、FSH水平会下降,继而出现低雌激素状态相关的血管舒缩症状,补肾祛瘀法在防治EMT腹腔镜术后应用GnRH-a致血管舒缩综合征方面有一定的疗效,其可不通过改变E2、FSH水平而改善血管舒缩症状。
[Abstract]:Objective to observe the therapeutic effect of tonifying kidney and removing blood stasis method on patients with renal deficiency and blood stasis syndrome after laparoscopic operation of endometriosis and to provide scientific basis for clinical application of GnRH-a in the prevention and treatment of vasomotor syndrome. To increase the patient's tolerance to GnRH-a, improve the therapeutic effect and reduce the incidence of vasomotor syndrome caused by GnRH-a after endoscopical laparoscopy. Methods from July 2015 to December 2016, 60 patients diagnosed by laparoscopy in gynecological ward of people's Hospital affiliated to Fujian University of traditional Chinese Medicine were randomly divided into experimental group and control group. 60 patients with kidney deficiency and blood stasis syndrome were treated with GnRH-a. There were 30 cases in each group, the experimental group was treated with traditional Chinese medicine, and the prescription of tonifying kidney and removing blood stasis was selected. After the operation, one dose, two packets, one packet each, one pack early and one packet late, was taken from the first day after injection of Leuprorelin Acetate, and the oral dose was taken orally for 21 days after meal, half an hour after meal. There were three courses of treatment. The control group was subcutaneously injected with Leuprorelin Acetate for three injections without any other treatment. If the symptoms of vasomotor syndrome are obvious, oryzanol is given orally, 1 tablet once, 3 times a day. The therapeutic effect was evaluated 28 days after the third injection. The changes of renal, blood stasis score and grading were observed before and after treatment, and the occurrence of vasomotor syndrome and the changes of E2FSH in the two groups were observed. The data were analyzed statistically. Result 1. There was no significant difference in renal blood stasis score and grade between the two groups before treatment. After treatment, the renal score and grade in the experimental group were lower than that before treatment, while the renal score and grade in the control group were higher than those before treatment. After treatment, the blood stasis score and grade of the two groups were lower than that before treatment, and the blood stasis score and grading of the experimental group were lower than that of the control group. There was no significant difference in the level of E2FSH between the two groups before and after treatment. After treatment, the level of E2FSH in the two groups was lower than that before treatment (P0.05), but there was no significant difference in the level of E2FSH between the two groups after treatment. There was no vasomotor syndrome in the two groups before treatment. After treatment, paroxysmal heat, flashes, sweating, palpitation and the score of vasomotor syndrome in the experimental group were lower than those in the control group (P 0.05). Conclusion 1. The patients who were diagnosed as EMT after laparoscopy and were diagnosed as kidney deficiency and blood stasis syndrome were treated with GnRH-a. The degree of kidney deficiency was easily aggravated and the degree of local blood stasis was improved during the operation. However, the injury of blood collaterals in operation was bound to lead to no net depletion of blood. The method of tonifying kidney and removing blood stasis can improve blood stasis score and grade by reducing renal integral and grading. Under the action of GnRH-a, the level of E2FSH in patients will decrease, and then there will be vasomotor symptoms associated with low estrogen status. The method of tonifying kidney and removing blood stasis has a certain curative effect in preventing and treating vasomotor syndrome caused by GnRH-a after EMT laparoscopy. It can improve vasomotor symptoms without changing E _ 2 FSH levels.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R713

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