药物治疗输卵管妊娠包块变化的临床研究

发布时间：2018-11-05 20:55

【摘要】：目的:本研究观察我院过去五年内的输卵管妊娠药物治疗患者,在"输卵管妊娠诊疗方案"指导治疗下,输卵管妊娠药物保守治疗成功的附件残留包块及盆腔积液等方面的临床疗效;通过对比分析各组治疗前后的包块大小以及已破损期治疗前后盆腔积液情况,以探讨中医药治疗的作用机理,为治疗本病提供客观详实的依据,也为输卵管妊娠诊疗方案的进一步优化提供建议。方法:采用回顾性分析方法,回顾广州中医药大学第一附属医院妇科病房中,于2012年1月1日至2016年12月31日住院的共1730例输卵管妊娠患者,严格按照纳入标准和排除标准筛选出符合要求的病例245例。所有纳入病例均符合"输卵管妊娠中西医结合治疗方案"中中医或中西医结合药物治疗规范,同时满足出院时血β-hCG转阴或下降≥90%。按照病例信息采集表,记录患者入院时的临床症状、妊娠三项结果、妊娠包块大小、盆腔积液以及出院时复查的妊娠指标数值,并根据上述信息制作Excel表格并建立数据库,将收集的患者资料进行归纳。按照患者的辨病分期和辨证分型(详见表1)以及输卵管妊娠病情影响因子积分(详见表2)进行分组,共分成5组,依次用A-E表示。其中A、B组采用中药治疗,C、D、E组予中西医结合药物治疗,分别比较各组治疗前后的包块变化情况。所有数据采用SPSS 22.0统计软件包进行统计学处理,结果均以x±s表示,各组前后包块变化采用Wilcoxo符号秩和检验,P0.05视为有统计学差异。结果:1.A组:未破损期胎元阻络型,积分≤8分,血β-hCG1000IU/L时,治疗前后妊娠包块体积变化有统计学差异,同时观察治疗前后妊娠包块大小的平均值,有明显下降趋势。2.B组:已破损期正虚血瘀型,积分≤9分,血β-hCG1000IU/L,治疗前后平均妊娠包块体积、盆腔积液体积有明显下降。但因观察时间、个体差异等,可能导致了统计学上未显示差异性。3.C组:未破损期胎元阻络型,积分≤8分,血β-hCG≥1000IU/L或包块最大径5cm时,治疗后输卵管妊娠平均包块体积均较前有所增长。对比A组结果,考虑包块的消散可能与妊娠滋养细胞活性相关。4.D组:未破损期胎元阻络型中积分=9-10分,治疗后的平均妊娠包块体积均有明显减小趋势。5.E组:已破损期正虚血瘀型中积分≤9分,血β-hCG≥1000IU/L时,治疗后平均包块体积有所下降,但下降趋势缓慢,盆腔积液下降趋势明显。6.考虑妊娠包块内部张力与滋养细胞活性间关系,按照妊娠包块纵/横径比值分为比值2和比值≥2两组,已破损期孕酮值比较,差异有统计学意义,余均无统计学差异。说明包块纵/横径比大小与滋养细胞活性无明显关联。但根据两组指标均值比较,妊娠包块纵/横比2和比值≥2组中,纵/横比较大时,血β-hCG值和P值相对较低。推测输卵管妊娠包块纵/横比越大,可能更易出现输卵管妊娠破裂或流产情况发生。而结合孕酮作用机制：P水平低下时,无法维持妊娠,又无法拮抗雌激素对输卵管平滑肌的节律性收缩,可能导致输卵管妊娠流产。这恰好与本研究结果一致。7.经治疗,A至E各组对包块改善的有效率分别为71.9%、63.64%、51.61%、63.64%、76.47%。整体总有效率68.16%。可以看出,C组即对应的未破损期胎元阻络型,当积分≤8分,hCG≥1000IU/L或输卵管妊娠包块最大径≥5cm时,妊娠包块缩小方面效果不显,推测针对该型患者,治疗过程中需增加针对减小包块的治疗,如相对加大活血化瘀消ve力度,从而加快输卵管妊娠包块的消散。结论:1.输卵管妊娠中西医结合诊疗方案在发挥中医药杀胚治疗的同时,对输卵管妊娠包块的治疗有效。对于抑制输卵管妊娠包块的增大,加速包块吸收,改善盆腔血液循环状况,缓解症状方面具有显著的优势。2.针对未破损期胎元阻络型,积分≤8分,血β-hCG≥1000IU/L或包块最大径≥5cm的患者,建议今后治疗过程中增加针对性治疗,如相对加大活血化瘀消ve力度,加快输卵管妊娠包块的消散。3.包块纵/横径比值与滋养细胞活性无明显关联,但当输卵管妊娠包块纵/横比较大时,可能更易出现输卵管妊娠破裂或流产情况发生。
[Abstract]:Objective: To observe the clinical effect of tubal pregnancy drug conservative treatment in patients with tubal pregnancy and pelvic effusion in the past five years in our hospital under the guidance of "The diagnosis and treatment plan of tubal pregnancy". By contrasting and analyzing the size of the bag before and after the treatment and the cases of pelvic effusion before and after treatment, the mechanism of the treatment of traditional Chinese medicine was discussed, and the objective and detailed basis for the treatment of the disease were provided, and the suggestion was also made for the further optimization of the diagnosis and treatment scheme of the tubal pregnancy. Methods: Retrospective analysis was used to retrospectively analyze the cases of tubal pregnancy in the first affiliated hospital of Guangzhou University of Traditional Chinese Medicine, which was admitted on Jan. 1, 2012 to December 31, 2016, and 245 cases were screened according to the criteria and exclusion criteria. All included cases are in accordance with Chinese medicine or traditional Chinese and western medicine combination drug treatment specification in "Treatment of tubal pregnancy combined with traditional Chinese and western medicine", and at the same time, the amount of blood-hCG-hCG at discharge can be met or reduced by 90%. According to the case information collection table, record the clinical symptoms, three pregnancy outcomes, the size of the pregnancy package block, the pelvic effusion and the pregnancy index values reviewed during discharge, and prepare the Excel table according to the above information and establish a database to summarize the collected patient data. The group was divided into 5 groups according to the patient's disease stage and syndrome differentiation type (see Table 1) and the effect factor integration of tubal pregnancy (see Table 2 for details), which was expressed in sequence A-E. Group A and group B were treated with traditional Chinese medicine, C, D and E were treated with traditional Chinese and western medicine, and the changes of bag block before and after treatment were compared. All the data were subjected to statistical processing using SPSS 10.0 statistical software. The results were expressed as x/ s, and the changes of the pre-and post-post-package blocks in each group were treated with Wilcoxon signed rank and test, P0.05. Results: 1. A group: there was a statistical difference in the volume change of pregnancy bag before and after treatment, while the mean value of the block size of pregnancy bag before and after treatment was observed. The volume of the average gestational age group and the volume of pelvic effusion were significantly decreased before and after treatment. However, due to the observation time, individual difference and so on, there may be no statistically significant difference. Compared with the results of group A, the dissipation of the block was considered to be related to the activity of gestational trophoblastic cells. The volume of average bag block decreased, but the trend of decline was slow and the trend of pelvic effusion decreased. In consideration of the relationship between the internal tension of pregnancy bag block and the activity of trophoblast cells, the ratio of longitudinal/ transverse diameter ratio was divided into two groups: ratio 2 and ratio: 2 groups. The ratio of longitudinal/ transverse diameter of package block was not significantly associated with the activity of trophoblast cells. However, compared with the mean value of the two groups, the values of P-hCG and P were relatively low when the longitudinal/ transverse ratio of the pregnancy package was larger than that of the two groups. It is estimated that the greater the longitudinal/ lateral ratio of the tubal pregnancy package, the more likely the occurrence of tubal pregnancy rupture or miscarriage can occur. In combination with progesterone action mechanism: P level is low, pregnancy can not be maintained, and the rhythmic contraction of estrogen on tubal smooth muscle can not be antagonized, which may lead to abortion of tubal pregnancy. This is exactly consistent with the results of this study. 7. The effective rates of group A to E were 71.9%, 63. 64%, 51. 61%, 63. 64%, 76. 47%, respectively. Overall total effective rate was 68. 16%. It can be seen that the C group is the corresponding non-damaged fetus meta-resistance complex, when the score is 8 points, the hCG concentration is 1000IU/ L or the maximum diameter of the tubal pregnancy bag block is 0.5cm, the effect on the reduction of the gestational bag block is not obvious, therefore, the treatment for reducing the bag block needs to be increased in the treatment process aiming at the patients with the type. such as increasing blood circulation and removing blood stasis and removing blood stasis so as to speed up the dissipation of the tubal pregnancy bag block. Conclusion: 1. The treatment scheme of tubal pregnancy and western medicine combined with the diagnosis and treatment of tubal pregnancy is effective for the treatment of tubal pregnancy bag block. It has a significant advantage in inhibiting the enlargement of the tubal pregnancy bag block, accelerating the absorption of the bag block, improving the pelvic blood circulation condition and relieving the symptoms. Aiming at the patients with non-damaged pregnancy meta-resistance, the score was 8 points, the blood count-hCG ratio was 1000IU/ L or the maximum diameter of the bag block was 0.5cm, it was suggested to increase the targeted treatment in the future treatment, such as increasing blood circulation and removing blood stasis and eliminating eve, and speeding up the dissipation of the block of tubal pregnancy. The ratio of longitudinal/ transverse diameter of the package block is not significantly associated with the activity of trophoblast, but when the longitudinal/ transverse comparison of the tubal pregnancy bag block is large, the occurrence of tubal pregnancy rupture or abortion may be more likely to occur.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.22

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