温针灸督脉治疗肾虚血瘀型多囊卵巢综合征不孕的临床研究

发布时间：2017-12-27 11:00

本文关键词：温针灸督脉治疗肾虚血瘀型多囊卵巢综合征不孕的临床研究　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察温针灸督脉对肾虚血瘀型多囊卵巢综合征不孕的临床疗效,旨在充分发挥中医特色,为多囊卵巢综合征不孕的治疗增添新的思路和方法。方法:采用随机对照研究方法,将符合条件的60例肾虚血瘀型多囊卵巢综合征不孕患者,随机分为治疗组(温针灸督脉)和对照组(克罗米芬)各30例。治疗组:运用温针灸督脉(百会、大椎、身柱、至阳、命门、腰阳关、十七椎、肾俞(双侧),穴位处常规消毒,常规针刺法得气后,针身上添加薄纸皮,且于针柄插入点燃艾柱,所有穴位均行温针灸2壮,时间约30min。自月经第5天(自然周期或口服黄体酮胶丸100mg bid 5天撤退出血)开始治疗,隔日治疗1次,1个月经周期为1个疗程,直到下次月经来潮停止针灸,经期禁止针灸。针对照组:月经周期第5天(自然周期或口服黄体酮胶丸100mg bid 5天撤退出血)开始服用克罗米芬50mg/d×5天。2组患者均在月经期第10、12、14天行阴道B超监测卵泡发育情况,当B超监测卵泡直径达18～25mm形成优势卵泡时,配合肌肉注射人绒毛膜促性腺素(HCG)10000U,并指导同房。2组治疗疗程为均3个月经周期,一旦受孕即停止治疗。观察比较2组患者的BMI、中医临床症候、性激素、卵泡发育、排卵情况、妊娠率等相关指标,运用统计学方法分析两组实验数据,得出结论。评价温针灸督脉的临床疗效。结果:1.一般基础情况比较治疗前两组年龄、病程比较,P值均0.05,差异无统计学意义,说明两组基线水平具有可比性。2.临床疗效观察(1)临床总疗效分析治疗组总疗效率86.66%,对照组总疗效率60%,两组比较P0.05,无统计学意义。说明两组在总的疗效方面相同。(2)中医症候积分、中医疗效分析治疗前两组中医症候积分、中医疗效比较,均无统计学意义(P0.05)。治疗后中医积分的中位数治疗组4低于对照组5,具有显著性差异(P0.05)。治疗后中医疗效治疗组有效率83.33%高于对照组70%,具有显著性差异(P0.05)。说明治疗组在改善中医症候、中医疗效方面优于对照组。中医积分治疗前后差值t=2.251,p=0.029,说明治疗后两组中医症候比较有明显性差异,温针灸督脉组优于西药组。(3)BMI分析治疗前两组BMI比较P0.05,差异无统计学意义,说明两组具有可比性。治疗后与治疗前两组内比较有显著性差异(P0.01,治疗前后差值比较,P0.01,说明治疗后两组间比较具有统计学意义(P0.05),治疗组在改善患者BMI方面优于对照组。(4)性激素分析治疗前两组性激素比较均0.05,差异无统计学意义,说明两组具有可比性。治疗后两组性激素比较,LH、LH/FSH比较P0.05差异有统计学意义;其余FSH、T比较P0.05,差异无统计学意义。2组治疗前后差值LH比较P0.05,具有统计学意义,其余均P0.05,差异无统计学意义。提示温针灸督脉组在改善性激素值方面优于对照组。说明温针灸督脉能调节HP0A轴,促进下丘脑-垂体-卵巢功能恢复,从而有助于成熟卵泡的发育及子宫内膜生长,提高排卵率及妊娠率。(5)卵泡大小、子宫内膜厚度分析治疗前两组卵泡大小、子宫内膜厚度比较PO.05,差异无统计学意义,说明两组具有可比性。治疗后两组卵泡大小、子宫内膜厚度比较P0.05,且在治疗前后差值,卵泡大小、子宫内膜厚度p=0.000,两组具有明显差异性,具有统计学意义,治疗组优于对照组。(6)排卵次数分析在治疗期间,两组在排卵次数方面,温针灸督脉具有同等克罗米芬的治疗效果,二者无统计学差异(P0.05)。(7)妊娠率分析:治疗后,治疗组妊娠率40%,妊娠人数12人;对照组,妊娠率23.33%,妊娠人数7人,治疗组高于对照组,两组患者的妊娠率比较无统计学意义(P0.05)。说明两组在妊娠结局方面疗效相同。结论:温针灸督脉治疗肾虚血瘀型多囊卵巢综合征性不孕,总的临床疗效、排卵次数、妊娠率等同于克罗米芬。但在减轻体重指数、改善中医症候、性激素、增加子宫内膜厚度及卵泡大小方面较西药有优势;显示了针灸治疗本病的优越性,为中医辨证治疗本病提供客观依据。
[Abstract]:Objective: To observe the clinical curative effect of acupuncture and moxibustion on Du Meridian of polycystic ovarian syndrome with infertility, to give full play to the characteristics of traditional Chinese medicine, treatment for infertile women with polycystic ovary syndrome add new ideas and methods. Methods: a randomized controlled study method, will meet the conditions of the 60 cases of polycystic ovarian syndrome with infertility patients were randomly divided into treatment group (acupuncture Du Meridian) and control group (J Romy Finn) 30 cases. The treatment group: the use of acupuncture and moxibustion on Baihui and Dazhui (DU, column, to Yang, Mingmen, Yaoyangguan, seventeen vertebrae, Shenshu (bilateral) acupoints, routine disinfection, routine acupuncture method gas, needle body and needle to add skin tissue, handle is inserted into the ignited moxa, all points for acupuncture and moxibustion 2 strong, time is about 30min. Since the fifth day of the menstrual cycle (natural cycle or oral administration of Progesterone Soft Capsules 100mg bid 5 days withdrawal bleeding) started treatment, every other day for 1 times, 1 menstrual cycles for 1 course, until the next menstrual period to stop acupuncture, acupuncture is prohibited. The control group: the fifth day of menstrual cycle (natural cycle or oral administration of Progesterone Soft Capsules 100mg bid 5 days withdrawal bleeding) started taking clomiphene 50mg/d * 5 days. 2 groups of patients in the tenth, twelfth, fourteenth days of menstruation, vaginal ultrasound monitoring follicular development, when B-mode ultrasound monitoring follicular diameter of 18 ~ 25mm to form dominant follicles, combined with intramuscular injection of human chorionic gonadotrophin (HCG) 10000U, and guide the same room. The treatment course of the 2 groups was 3 menstrual cycles, and once the pregnancy was stopped, the treatment was stopped. The BMI, TCM clinical symptoms, sex hormones, follicular development, ovulation and pregnancy rate of 2 groups of patients were observed and compared. The two groups of experimental data were analyzed by statistical method, and the conclusion was drawn. To evaluate the clinical efficacy of warming acupuncture meridian. Results: 1. the comparison of the age and course of disease between the two groups before the treatment was compared, the P value was 0.05, the difference was not statistically significant, indicating that the baseline level of the two groups was comparable. 2. clinical curative effect observation (1) total clinical curative effect analysis treatment group total treatment efficiency 86.66%, the control group total treatment efficiency 60%, two groups compared P0.05, no statistical significance. The results showed that the two groups were the same in the total curative effect. (2) there was no statistical significance (P0.05) in the score of TCM syndrome and the curative effect of traditional Chinese medicine in the first two groups of TCM syndrome scores and the comparison of traditional Chinese medicine (TCM). After treatment, the median treatment group of traditional Chinese medicine score was 4 lower than that of the control group (5), with significant difference (P0.05). After treatment, the effective rate of the treatment group of Chinese medicine was 83.33% higher than that of the control group (70%), with significant difference (P0.05). It shows that the treatment group is better than the control group in improving the TCM syndrome and the curative effect of traditional Chinese medicine. Before and after the treatment of traditional Chinese medicine integral difference t=2.251 p=0.029, indicating the two groups after treatment of TCM symptoms comparison has the obvious difference, Du warm acupuncture group was better than control group. (3) before BMI analysis, two groups of BMI were compared with P0.05, and the difference was not statistically significant, indicating that the two groups were comparable. There was a significant difference between the two groups after treatment (P0.01), the difference between before and after treatment was P0.01, indicating that there was statistical significance between the two groups after treatment (P0.05), and the treatment group was better than the control group in improving BMI. (4) the sex hormone analysis before treatment of the two groups of sex hormones were 0.05, the difference was not statistically significant, indicating that the two groups were comparable. After treatment, the differences of LH and LH/FSH in the two groups were statistically significant, and the other FSH and T compared to P0.05, the difference was not statistically significant. The difference between the 2 groups before and after treatment was compared with P0.05, and the difference was statistically significant, the rest were P0.05, and the difference was not statistically significant. Warm acupuncture group in improvement of hormone values than the control group. That acupuncture and moxibustion can regulate the Du HP0A axis, promote the recovery of ovarian function of hypothalamic pituitary, which contributes to the development of mature follicle and endometrial growth, improve the ovulation rate and pregnancy rate. (5) follicle size and endometrial thickness were analyzed before treatment. There was no statistically significant difference in follicle size and endometrial thickness between the two groups before treatment. The difference between the two groups was not statistically significant, indicating that the two groups were comparable. After treatment, the follicle size and endometrial thickness of the two groups were P0.05 compared with that of the control group, and the difference between the two groups before and after treatment, the size of follicle and the thickness of endometrium were p=0.000. There was significant difference between the two groups, which was statistically significant, and the treatment group was better than the control group. (6) the number of ovulation during treatment, two groups in ovulation, warm acupuncture Du meridian has the same clomiphene treatment effect, no statistical difference between the two (P0.05). (7) pregnancy rate analysis: after treatment, the pregnancy rate of the treatment group was 40%, and the number of pregnant women was 12. In the control group, the pregnancy rate was 23.33%, the number of pregnant women was 7, the treatment group was higher than that of the control group, and the pregnancy rate of two groups was not statistically significant (P0.05). The results showed that the two groups had the same effect in the outcome of pregnancy. Conclusion: the syndrome infertility with acupuncture and moxibustion on treatment of polycystic ovary syndrome, the clinical efficacy, ovulation and pregnancy rate equivalent to clomiphene. But it has advantages in reducing body mass index, improving TCM symptoms, sex hormones, increasing endometrial thickness and follicle size, showing the superiority of acupuncture in treating this disease, and providing objective basis for TCM treatment based on syndrome differentiation.
【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】：R246.3

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