盆底肌按摩对行IVF的卵巢低反应不孕患者妊娠结局影响的临床研究

发布时间：2019-01-17 09:27

【摘要】：目的：观察盆底肌按摩对行IVF的卵巢低反应不孕患者妊娠结局影响的临床疗效。通过对分析盆底肌按摩对患者卵巢血流及内分泌水平的影响，初步探讨其作用机理。方法：收集2012年10月至2013年11月就诊于山东中医药大学第二附属医院生殖医学中心的行IVF并符合卵巢低反应诊断标准的患者共80例，随机分为观察组40例，对照组40例。观察组给予盆底肌按摩联合西药人工周期治疗，即月经干净开始给予盆底肌按摩20分钟，频率为50HZ，穴位为会阴穴、会阳穴、长强穴、腰俞穴、八毼穴，每日一次，用至下次月经来潮；月经第3天服用雌二醇片/雌二醇地屈孕酮片复合包装，先服白片1mg po qd，连续应用14天，继服灰片11mg po qd，连续应用14天待月经来潮。对照组只予以西药人工周期；均治疗3个月经周期。比较两组患者治疗前后月经第2天基础内分泌水平，卵巢动脉搏动指数（PI）、阻力指数（RI）、收缩期/舒张期血流指数（S/D）及窦卵泡数。两组患者给予改良超短方案超促排卵治疗，同时观察组继续给予盆底肌按摩至HCG日，观察两组患者Gn用量、用药天数、子宫内膜厚度、HCG注射日的E2、LH、P的水平，获卵数、受精数、卵裂数、优胚数、冻胚数、胚胎种植数、临床妊娠率及周期取消率。结果：两组患者治疗前一般资料比较差异无统计学意义（P＞0.05），具有可比性。两组患者超促排卵治疗前的一般资料比较无统计学差异（P＞0.05）。治疗3个月经周期后：组内比较：1.观察组治疗后较治疗前bFSH水平、卵巢动脉血流指数PI、RI、S/D降低均明显下降（P＜0.05），AMH明显提高（P＜0.05），窦卵泡数明显增加（P＜0.05）。2.对照组治疗后较治疗前bFSH水平明显下降（P＜0.05），，AMH水平提高（P＜0.05）。组间比较：1.治疗后观察组与对照组比较bFSH下降10%（P＜0.05）；AMH提高15%（P＜0.05）；窦卵泡数增加11%（P＜0.05）；卵巢动脉血流指数PI、RI、S/D明显下降（P＜0.05）。2.HCG注射日观察组E2水平和子宫内膜厚度较对照组高，差异有统计学意义（P＜0.05）。3.观察组获卵数、优胚数、冻胚数明显高于对照组，差异有统计学意义（P＜0.05）。4.观察组临床妊娠率明显高于对照组，差异有统计学意义（P＜0.05）。结论：盆底肌按摩可以通过对盆底穴位刺激，增加盆腔血流灌注，从而增加卵巢血流灌注，改善卵巢储备功能，增加获卵数，提高妊娠率。
[Abstract]:Objective: to observe the clinical effect of pelvic floor massage on pregnancy outcome of infertile patients with ovarian hypopreactivity (IVF). By analyzing the effect of pelvic floor massage on ovarian blood flow and endocrine level, the mechanism of pelvic floor massage was discussed. Methods: from October 2012 to November 2013, 80 patients who were treated for IVF in the Center of Reproductive Medicine, second affiliated Hospital of Shandong University of traditional Chinese Medicine, were randomly divided into observation group (n = 40) and control group (n = 40). The observation group was given pelvic floor massage combined with western medicine artificial cycle therapy, that is, the pelvic floor muscle massage was given for 20 minutes after menstruation, the frequency was 50HZ, the acupoints were perineum point, Huiyang point, Changqiang point, Yaoshu point, Bazui point, once a day. Use to the next menstruation; On the 3rd day of menstruation, the combination packaging of estradiol / estradiol diproprogesterone tablets was taken. White tablet 1mg po qd, was taken for 14 days, followed by grey tablet 11mg po qd, for 14 days to wait for menstrual onset. The control group was only given artificial cycle of western medicine, and all of them were treated for 3 menstrual cycles. The basal endocrine level, (PI), resistance index (PI), systolic / diastolic blood flow index (S / D) and the number of antral follicles were compared between the two groups before and after treatment. Two groups of patients were treated with modified ultrashort regimen for hyperstimulation of ovulation, while the observation group continued to receive pelvic floor muscle massage until the day of HCG. The dosage of Gn, the days of medication, the thickness of endometrium, the level of E _ 2 LHN P on the day of HCG injection, and the number of eggs obtained were observed in the two groups. Fertilization number, cleavage number, superior embryo number, frozen embryo number, embryo implantation number, clinical pregnancy rate and cycle cancellation rate. Results: there was no significant difference in general data between the two groups before treatment (P > 0.05). There was no significant difference in general data between the two groups before treatment (P > 0.05). Treatment after 3 menstrual cycles: intragroup comparison: 1. In the observation group, compared with that before treatment, the PI,RI,S/D of ovarian artery blood flow index decreased significantly (P < 0. 05) and the number of antral follicles increased significantly (P < 0. 05). The level of bFSH in control group was significantly lower than that before treatment (P < 0. 05, P < 0. 05). Comparison between groups: 1. Compared with the control group, the bFSH decreased by 10% (P < 0. 05), the number of follicles increased by 15% (P < 0. 05), the number of antral follicles increased by 11% (P < 0. 05). The level of E2 and the thickness of endometrium in the observation group were significantly higher than those in the control group (P < 0. 05) on the day of 2.HCG injection (P < 0. 05). The number of eggs, excellent embryos and frozen embryos in the observation group was significantly higher than that in the control group (P < 0.05). The clinical pregnancy rate in the observation group was significantly higher than that in the control group (P < 0.05). Conclusion: pelvic floor massage can increase the perfusion of pelvic blood flow, improve ovarian reserve function, increase the number of eggs and increase the pregnancy rate by stimulating the pelvic floor points.
【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】：2014
【分类号】：R711.6

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