中药联合达肝素钠治疗子宫动脉血流异常的复发性流产的临床研究

发布时间：2018-11-04 10:49

【摘要】：目的:本课题研究的目的为运用自拟方补肾活血汤联合达肝素钠针治疗子宫动脉血流异常的复发性流产。通过对临床疗效的观察,总结中药联合达肝素钠在治疗子宫动脉血流异常的复发性流产中的优势,为提高药物治疗复发性流产的临床疗效提供依据。方法:本研究将子宫动脉血流异常的复发性流产(肾虚血瘀型)患者60例,随机分成治疗组与对照组,每组各30人。治疗组予自拟方补肾活血汤口服联合达肝素钠针皮下注射,对照组单纯予以达肝素钠针皮下注射。14天为一疗程,治疗至妊娠满12周或超过既往流产时间。通过检测治疗组与对照组治疗前后的人绒毛膜促性腺激素、孕酮及超声下胚胎发育情况、子宫动脉血流阻力变化情况,观察两组患者治疗后的临床疗效及妊娠结局。结果:1.在临床总疗效的比较上,治疗组治愈16例,占53.33%,显效4例,占13.33%,有效6例,占20.00%,无效4例,占13.33%,总有效率86.67%;对照组治愈6例,占20.00%,显效3例,占10.00%,有效7例,占23.33%,无效14例,占46.67%,总有效率53.33%,治疗组优于对照组(P0.05)。2.在证候积分的比较上,治疗组治疗前后和对照组治疗前后的证候积分在差异上均具有显著的统计学意义(P0.01),治疗组与对照组治疗后证候积分具有显著的统计学差异(P0.01)。3.在子宫动脉血流阻力指数上,治疗组治疗前后和对照组治疗前后的子宫动脉血流双侧RI、S/D差异均有显著的统计学意义(P0.01),治疗组与对照组治疗后的双侧RI、S/D差异均具有统计学意义(P0.05)。4.在血清β-HCG和孕酮(P)比较中,治疗组和对照组治疗前后即妊娠6周末与10周末的血清β-HCG和P差异均有显著的统计学意义(P0.01),治疗组与对照组治疗后即妊娠10周末的血清β-HCG和P差异具有统计学意义(P0.05)。5.在两组患者治疗后妊娠结局的比较中,治疗组26例治愈,4例无效,其总有效率为86.67%,对照组17例治愈,13例无效,总有效率为56.67%,治疗组与对照组的妊娠结局具有统计学差异(P0.05)。对两组患者随访中,胎儿及婴儿均未见发育畸形。结论:补肾活血方联合达肝素钠针能明显提高子宫动脉血流异常的复发性流产的妊娠成功率,并能降低子宫动脉血流阻力,调节血液循环,其临床疗效可靠,值得推广。
[Abstract]:Objective: to treat recurrent abortion with Bushen Huoxue decoction and Diheparin Sodium Needle in the treatment of uterine artery blood flow abnormality. Through the observation of clinical curative effect, the advantages of combination of traditional Chinese medicine and diheparin sodium in the treatment of recurrent abortion with abnormal uterine artery blood flow were summarized in order to provide the basis for improving the clinical efficacy of medicine in the treatment of recurrent abortion. Methods: 60 patients with recurrent abortion (kidney deficiency and blood stasis) with abnormal uterine artery blood flow were randomly divided into treatment group and control group with 30 patients in each group. The treatment group was treated with self-formulated Bushen Huoxue decoction and subcutaneous injection of sodium dheparin, while the control group was only given subcutaneous injection of sodium dharparin. 14 days was a course of treatment, until the pregnancy reached 12 weeks or more than the time of previous abortion. The development of human chorionic gonadotropin progesterone and ultrasound and the changes of uterine artery blood flow resistance were measured before and after treatment in the treatment group and control group. The clinical efficacy and pregnancy outcome of the two groups were observed. The result is 1: 1. 16 cases were cured in the treatment group (53.33%), 4 cases were markedly effective (13.33), 6 cases (20.00%) were effective, 4 cases were ineffective (13.33%), and the total effective rate was 86.67 (P < 0.05). In the control group, 6 cases were cured (20.00%), 3 cases were markedly effective (10.00%), 7 cases were effective (23.33 cases), 14 cases (46.67%) were ineffective, and the total effective rate was 53.33%. The treatment group was better than the control group (P0.05). In the comparison of syndrome score, the difference of syndrome score before and after treatment in treatment group and control group was statistically significant (P0.01). Treatment group and control group after treatment had significant difference in syndrome score (P0.01). In the uterine artery blood flow resistance index, there were significant differences in bilateral RI,S/D between the treatment group and the control group before and after treatment (P0.01). The bilateral RI, in the treatment group and the control group after treatment were significantly different (P0.01). The difference of S / D was statistically significant (P0.05). In the comparison of serum 尾-HCG and progesterone (P), there were significant differences in serum 尾-HCG and P between the treatment group and the control group before and after treatment, that is, at the 6th and 10th week of pregnancy (P0.01). The serum 尾-HCG and P in the treatment group and the control group were significantly different from those in the control group after 10 weeks of pregnancy (P0.05). In the two groups, 26 cases were cured, 4 cases were ineffective, and the total effective rate was 86.67%. In the control group, 17 cases were cured, 13 cases were ineffective, and the total effective rate was 56.67%. The pregnancy outcomes of the treatment group and the control group were statistically different (P0.05). There were no developmental deformities in the fetus and infants during the follow-up of the two groups. Conclusion: Bushen Huoxue prescription combined with heparin sodium needle can significantly improve the pregnancy success rate of recurrent abortion with abnormal uterine artery blood flow, reduce uterine artery blood flow resistance, regulate blood circulation, and its clinical efficacy is reliable and worth popularizing.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.21

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