莪棱元坤合剂联合西药治疗胎盘植入临床分析

发布时间：2018-09-08 20:36

【摘要】：目的:通过回顾性病例分析探讨胎盘植入的发病因素,并总结莪棱元坤合剂联合西药治疗胎盘植入的临床疗效及安全性,以期为胎盘植入的规范性诊疗寻找一个有效、安全、低毒的最佳治疗方案,为莪棱元坤合剂的推广应用提供临床依据。方法:选取山东省立医院妇产科病房2014年1月-2016年12月收治的98例胎盘植入患者,按照1:2的比例随机抽取同期196例非胎盘植入产妇作为对照,对两组年龄、文化程度、孕产次等一般资料进行研究分析,以探讨本病的发病因素;并根据治疗用药情况将收集到的胎盘植入患者进行分组:其中应用“莪棱元坤合剂+甲氨蝶呤+米非司酮方案”治疗的30例(A组),用“甲氨蝶呤+米非司酮方案”治疗的26例(B组),分析比较两组的临床总体疗效、人绒毛膜促性腺激素(血β-HCG值)治疗前后变化情况、胎盘植入面积大小变化、阴道流血情况及药物毒副作用。结果:通过胎盘植入组与同期非胎盘植入组一般临床特征比较分析可见,高龄、孕产次、流产史、前置胎盘和妊娠合并高血压疾病是胎盘植入的危险致病因素,其中前置胎盘和妊娠合并高血压疾病则是胎盘植入的独立危险因素。在临床疗效方面,A组治疗有效率为100%,B组治疗有效率为84.61%,两组比较有差异性(P0.05)。在降低血β-HCG值方面,两组治疗后血β-HCG值均较治疗前有明显下降(P0.01);治疗后的血β-HCG值A组下降更为明显,与B组比较有显著差异性(P0.01)。在胎盘植入面积方面,两组治疗后较治疗前明显缩小(P0.01);A组胎盘植入面积缩小情况较B组更为显著,差异有统计学意义(P0.05)。在子宫缩复情况方面,两组治疗后较治疗前有显著差异性(P0.01);A组促进产后子宫修复的作用明显高于B组,两组比较有显著差异性(P0.01)。在治疗阴道流血方面,A组的阴道流血停止时间明显短于B组,两组比较有显著差异性(P0.01)。从不良反应及药物的毒副反应方面来讲,A组出现食欲减退、恶心呕吐、腹胀腹泻、过敏反应及药物毒副反应的例数明显少于B组,两组比较有差异性(P0.05)。结论:莪棱元坤合剂、甲氨蝶呤、米非司酮三药联用是保守治疗胎盘植入的有效方法,莪棱元坤合剂既提高了临床治疗的有效率,同时减轻了药物的毒副作用,而且能促进子宫修复和胎盘植入组织坏死、脱落,最大程度上保留了女性的生殖功能,不失为临床上用之有效的中药制剂,值得推广应用。
[Abstract]:Objective: to explore the etiological factors of placenta accreta by retrospective case analysis, and to summarize the clinical efficacy and safety of Eulingyuan Kun mixture combined with western medicine in the treatment of placenta accreta, in order to find an effective and safe way for the normative diagnosis and treatment of placenta accreta. The best treatment scheme of low toxicity provides clinical basis for the popularization and application of E-Leng Yuankun mixture. Methods: 98 patients with placenta accreta were selected from the Department of Obstetrics and Gynecology of Shandong Provincial Hospital from January 2014 to December 2016. 196 women with non-placenta implantation were randomly selected as control group according to the proportion of 1:2. The age and education level of the two groups were compared. The general data of pregnancy and parturition were studied and analyzed in order to explore the pathogenesis of the disease. The patients were divided into three groups according to the medication: 30 cases were treated with methotrexate mifepristone regimen (group A), and 30 cases were treated with "methotrexate mifepristone regimen" (group A), and the patients were treated with "methotrexate mifepristone regimen" (group A). "A total of 26 cases (group B) were treated, and the overall clinical efficacy of the two groups was analyzed and compared. The changes of human chorionic gonadotropin (尾 -HCG), placenta accreta area, vaginal bleeding and side effects were observed before and after treatment. Results: comparing the general clinical features of placenta accreta group and non-placental accreta group, we can see that the risk factors of placenta accreta are old age, pregnancy, abortion history, placenta previa and pregnancy complicated with hypertension. Placenta previa and pregnancy with hypertension are independent risk factors of placenta accreta. In terms of clinical efficacy, the effective rate of treatment in group A was 100%. The effective rate of treatment in group B was 84.61, and there was a difference between the two groups (P0.05). In terms of reducing serum 尾 -HCG value, the serum 尾 -HCG value in both groups was significantly lower than that before treatment (P0.01), and the serum 尾 -HCG value in group A was significantly lower than that in group B (P0.01). In the area of placenta accreta, the two groups significantly reduced the area of placenta accreta after treatment (P0.01) than that of group B (P0.01), the difference was statistically significant (P0.05). In terms of uterine contractions, there was significant difference between the two groups after treatment (P0.01). The effect of group A on postpartum uterine repair was significantly higher than that of group B (P0.01), and there was a significant difference between the two groups (P0.01). In the treatment of vaginal bleeding, vaginal bleeding in group A was significantly shorter than that in group B, and there was significant difference between the two groups (P0.01). From the side effects and side effects of drugs, the number of cases of appetite loss, nausea and vomiting, abdominal distension and diarrhea, allergic reactions and drug side effects in group A was significantly lower than that in group B, and there was significant difference between the two groups (P0.05). Conclusion: the combination of eolingyuankun mixture, methotrexate and mifepristone is an effective method for the conservative treatment of placenta accreta. Eulingyuankun mixture not only improves the effective rate of clinical treatment, but also alleviates the toxic and side effects of the drug. Moreover, it can promote uterine repair and placental accreta necrosis and exfoliation, and retain the female reproductive function to the maximum extent. It is an effective traditional Chinese medicine preparation for clinical use, which is worth popularizing and applying.
【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】：2017
【分类号】：R714.2

【参考文献】