补肾益气和血法联合黄体酮和绒促性素防治不明原因复发性流产的临床研究

发布时间：2019-01-22 09:38

【摘要】：目的本研究的目的是了解补肾益气和血法联合黄体酮和人绒毛膜促性腺激素防治不明原因复发性流产（URSA）的临床疗效，证明是否能改善URSA患者的妊娠结局，提高妊娠成功率，并探讨URSA的病因病机和治则治法，为中西医结合防治URSA的优势提供临床科学依据。方法本研究将符合研究标准的43例URSA患者纳入研究对象，孕前以补肾益气活血方为基本方，在辩证基础上给予中药治疗，以一个月为一个治疗周期，一般治疗三个周期，或待临床症状、全身状况改善后开始试孕。孕后给予补肾益气养血方加减联合黄体酮和人绒毛膜促性腺激素治疗。中药每日一剂煎服，早晚各一次，每次200ml，西药根据查血β-HCG、孕酮（P）值调整剂量，黄体酮注射液20~100mg，，每日肌肉注射一次，使血P值维持在30~60ng/ml；注射用人绒毛膜促性腺激素2000~3000单位，每两日肌肉注射一次，使血β-HCG值持续稳定增长（停经8周之前），治疗至孕后12周或超过既往流产孕周。观察妊娠期间有无阴道流血情况、腹痛、腰酸等情况，监测血β-HCG、P值，观察妊娠结局，并根据年龄不同将URSA患者分为22~≤26岁、26~≤30岁、30~35岁三个年龄段，分析治疗对不同年龄段患者是否存在疗效差异。 结果本研究43例URSA患者再次妊娠率为72.09%，其中有5例患者发生再次流产，妊娠成功率为83.87%，其中小于30岁患者的妊娠率及妊娠成功率均高于大于30岁者（P＜0.05）。经过治疗，妊娠后血β-HCG值持续稳定增长（停经8周之前），血P值维持在30~60ng/ml，再次妊娠者先兆流产相关症状、小腹下坠或隐痛不适、纳差、大便稀溏、神疲肢倦或面色晦暗无华等得到改善，但腰酸不适症状无明显改善，临床症状疗效总有效率为83.87%，但与年龄无关。 结论URSA患者孕前给予中药补肾益气活血方加减，孕后给予补肾益气养血方加减联合黄体酮和人绒毛膜促性腺激素，可改善临床症状，维持血β-HCG、P值在较好水平，改善再次妊娠结局，提高再次妊娠率和妊娠成功率。
[Abstract]:Objective to investigate the clinical effect of tonifying kidney and supplementing qi and blood therapy combined with progesterone and human chorionic gonadotropin (HCG) in the prevention and treatment of unexplained recurrent abortion (URSA), and to prove whether it can improve pregnancy outcome and increase pregnancy success rate in patients with URSA. To explore the etiology, pathogenesis and treatment of URSA, to provide clinical scientific basis for the advantages of integrated Chinese and western medicine in the prevention and treatment of URSA. Methods in this study, 43 URSA patients who met the study criteria were included in the study. Before pregnancy, Bushen Yiqi Huoxue prescription was taken as the basic prescription, and the traditional Chinese medicine was given on the basis of dialectical treatment, one month as the treatment cycle, and three cycles of general treatment. Or wait for clinical symptom, whole body condition improves after begin to test pregnancy. After pregnancy, Bushen Yiqi Yangxue prescription plus or minus progesterone and human chorionic gonadotropin treatment. Traditional Chinese medicine decoction once a day, morning and evening, each time 200ml, the western medicine according to check blood 尾-HCG, progesterone (P) value adjustment dose, progesterone injection 20g 100mg, intramuscular injection once a day, so that the blood P value maintained at 30 ~ 60ng / ml; Human chorionic gonadotropin (HCG) 2000000 units was injected intramuscularly every two days. The serum 尾-HCG value increased steadily (before 8 weeks of menopause) and reached 12 weeks after pregnancy or exceeded the gestational week of previous abortion. To observe whether there were vaginal bleeding, abdominal pain, lumbar acid and so on during pregnancy, to monitor serum 尾-HCG,P value, to observe pregnancy outcome, and to divide URSA patients into three age groups according to their age: 22 ~ 鈮

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