生化汤加味协同卡前列甲酯栓减少剖宫产产后出血、恶露不绝的疗效研究

发布时间：2018-07-09 11:30

本文选题：卡前列甲酯栓 + 生化汤加味　；参考：《青岛大学》2017年硕士论文

【摘要】：目的本实验是在传统名方生化汤基础上进行辨证施治而自拟的方剂,对产后患者可起到促恶露排出、减少产后出血,促子宫复旧的显著疗效。结合产后气虚夹瘀最为常见的临床特点,增加益母草,配五灵脂、蒲黄化瘀止痛,加伍芥穗炭散风止血而不留瘀,最终配方成生化汤加味。在常规治疗基础上,研究将生化汤加味与卡前列甲酯栓联合应用于剖宫产术后治疗,观察其对产后出血、恶露不绝、子宫复旧、泌乳等的临床效果,看是否优于临床常规治疗效果。方法自2016年2月至2016年11月我院行剖宫产术产妇按实验资料选取要求抽取60例,按随机配对原则分为观察组和对照组,每组各30例。对照组采用缩宫素等常规治疗,观察组采用常规治疗的同时加卡前列甲酯栓1mg舌下含化,并且术后6小时口服生化汤加味每日一剂连续5天,观察记录两组产妇产后出血量、自主排气时间、子宫下降速度、恶露情况、乳汁分泌情况及不良反应。结果观察组可见术后2h、24h出血量同对照组相比明显减少(p0.0001)。观察组术后首次排气平均时间较对照组术后首次排气时间明显缩短,两组数据相比差异有统计学意义(p0.0001)。观察组在术后5天内的宫底高度、下降速度与对照组相比表现出明显统计学差异(p0.05)。观察组在产后血性恶露量、恶露持续时间与对照组相比有明显统计学差异(p0.05或p0.01)。观察组术后56天彩超子宫各径线之和明显小于对照组,两组数据相比差异有显著性意义(p0.001);观察组术后56天宫腔无积血者29例,达97%,少量积血者1例,约占3%,对照组术后56天宫腔无积血者24例,占80%,少量积血6例,占20%,观察组宫腔积血发生率明显低于对照组。观察组、对照组第2天泌乳率大致相同(p0.05),但第3、4、5天观察组乳足率同对照组相比具有明显优势,差异有统计学意义(p0.05)。治疗有效率及显效率观察组与对照组相比表现出统计学差异(p0.05)。结论生化汤加味同卡前列甲酯栓共同应用能明显减少产后出血,促进产后排气,还能明显促进子宫缩复,显著减少血性恶露,促进恶露收敛干净,能较好的促进子宫复旧,降低宫腔积血发生率,并能有效促进剖宫产术后产妇泌乳。术中卡前列甲酯栓与传统缩宫素联合起效迅速,作用时间较持久,能有效持续减少产后出血。术后应用生化汤加味充分发挥了祖国中医药不可替代的优势,药物应用不良反应较少,用药安全可靠,值得临床广泛应用。
[Abstract]:Objective this experiment is based on the traditional prescription of biochemical decoction dialectical treatment and self-prescription, postpartum patients can promote the excretion of lochia, reduce postpartum hemorrhage, promote the recovery of the uterus. Combined with the most common clinical characteristics of postpartum qi deficiency and blood stasis, the addition of Motherwort, with five Lingzhi, fuhuang Huayu to relieve pain, combined with mustard panicle charcoal wind to stop bleeding without leaving blood stasis, the final formula is modified biochemical soup. On the basis of routine treatment, the authors studied the clinical effect of modified biochemical decoction and carboprost methyl ester suppository on postpartum hemorrhage, lochia, uterine recovery, lactation, and so on. See if it is better than clinical routine treatment. Methods from February 2016 to November 2016, 60 cases of parturient undergoing cesarean section in our hospital were randomly divided into observation group and control group, 30 cases in each group. The control group was treated with oxytocin and other routine therapy, the observation group was treated with routine therapy and the treatment group was treated with carprost methyl ester suppository (1mg) with sublingual metaplasia, and was orally treated with Shenghua decoction for 5 days after operation. The amount of postpartum hemorrhage was observed and recorded in the two groups. Spontaneous venting time, uterine descending speed, lochia, milk secretion and adverse reactions. Results in the observation group, the blood loss at 2 hours after operation was significantly lower than that in the control group (p 0.0001). The mean time of the first exhaust in the observation group was significantly shorter than that in the control group, and the difference between the two groups was statistically significant (p 0.0001). There were significant differences in floor height and descending speed between the observation group and the control group within 5 days after operation (p0.05). The amount and duration of postpartum hematoxia in the observation group were significantly different from those in the control group (p0.05 or p0.01). In the observation group, the sum of the uterine lines on 56 days after operation was significantly smaller than that in the control group, and the difference between the two groups was significant (p0.001), and in the observation group, there were 29 cases (97%) with no hemorrhage in uterine cavity and 1 case with small amount of hemorrhage on the 56th day after operation. In the control group, 24 cases (80%) had no hemorrhage in uterine cavity at 56 days after operation, 6 cases (20%) had a small amount of hemorrhage, the incidence of uterine cavity hemorrhage in the observation group was significantly lower than that in the control group. In the observation group, the lactation rate of the control group on the second day was approximately the same (p0.05), but the milk foot rate of the observation group on the 3rd 4th day was significantly superior to that of the control group (p0.05). The effective rate and effective rate of treatment in the observation group were significantly different from those in the control group (p0.05). Conclusion the combined application of biochemical decoction and carboprost methyl ester suppository can significantly reduce postpartum hemorrhage, promote postpartum exhaust, significantly promote uterine contraction, significantly reduce hemorrhagic lochia, promote neatness of lochia, and promote uterine restoration. Reduce the incidence of intrauterine hemorrhage, and can effectively promote the lactation of parturient after cesarean section. The combination of carprost methyl ester suppository and traditional oxytocin was effective and lasting during operation, and could effectively reduce postpartum hemorrhage. The application of biochemical decoction after operation has brought into full play the irreplaceable advantages of traditional Chinese medicine, less adverse drug reactions, safe and reliable use of drugs, and worthy of extensive clinical application.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R719.8

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