电针脐周四穴为主加麦粒灸促排卵效应的临床疗效观察

发布时间：2017-12-27 14:00

本文关键词：电针脐周四穴为主加麦粒灸促排卵效应的临床疗效观察　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:观察针刺联合麦粒灸促排卵效应的临床疗效,评价并观察以培土健脾为理论基础的针刺方法的临床有效性,并初步探讨其作用机理,为证明针刺联合麦粒灸促排卵、改善子宫内膜厚度的优势提供参考。方法:将60例患者采用随机对照的方法分成两组,其中针灸组及西药组各30例,在月经周期第5天行下列治疗:1、针刺组:主穴:天枢(双)、水分、阴交、归来、足三里、三阴交配穴:气滞血瘀加血海、太冲;湿热下注加水道、次毼;血虚宫寒加关元、命门;痰浊瘀阻加阴陵泉、丰隆。腹部麦粒灸操作方法:取5mg左右精细艾绒,制成上尖、中粗、下尖而平便于放置的艾粒,直径约2mmm,高度约3mm,将相应穴位涂以药汁(该药汁为麦粒灸特效药汁,源自香港政府化验师张超翰医师家族传承)后,放置于体表,以线香点燃艾柱顶端,待患者觉局部灼痛后,以拇指指甲按压艾柱使其熄灭,以相同方法灸下一穴位。待灸法完成后5min去掉残余艾柱。以河图图式为理论基础,施灸穴位为:数字1施灸关元穴;点数2施灸双侧石关穴;点数3施灸滑肉门、天枢、外陵穴(均右侧);点数4施灸足阳明胃经的滑肉门至外陵穴之间(均左侧);点数5施灸水分、阴交、双侧肓俞,神阙穴仅作为取穴标志,不灸;点数6施灸双侧归来、双侧大赫、双侧府舍;点数7施灸双侧梁门、双侧阴都、中脘、梁门与阴都穴中点各施灸1壮;点数8、点数9以足太阴脾经为主,以腹哀穴、腹结穴为起止,均匀分布于腹部两侧之脾经;点数10在北方施灸大巨、四满、脐下1寸处、南方施灸太乙、商曲、脐上2寸处。针刺治疗完毕后立即予以腹部麦粒灸治疗,隔日治疗一次,连续治疗一个月为1个疗程,共治疗3个疗程。在月经或阴道有撤退性出血之第5天开始口服枸橼酸氯米芬胶囊,每日服用50mg,连用5天。2.西药组:口服克罗米芬,用法同针灸组。疗程中均记录服药情况及不良反应。两组各治疗观察3个月经周期,治疗期间妊娠者结束治疗。治疗前后记录患者年龄、病程、中医辨证分型、子宫内膜厚度、SDS抑郁量表、排卵次数和妊娠情况来进行临床疗效的评价。结果:两组患者在治疗期间均无脱落和剔除病例。两组患者治疗前在年龄、病程、中医辨证分型方面,P值均大于0.05,差异无统计学意义,表明两组患者在治疗前具有可比性。治疗前,针灸组SDS评分为44.63±11.49,西药组SDS评分为48.50±12.54,两组间经t检验,差异无统计学意义(P=0.220.05);治疗后,针灸组SDS评分为40.00±9.72,西药组SDS评分为46.27±9.45,两组治疗后SDS评分与治疗前相比均有明显差异(P0.05);比较治疗后两组间SDS评分,有明显的差异(P=0.020.05),总而言之,两种治疗方法均可降低患者的SDS评分,并且针灸组降低SDS评分方面优于西药组。治疗前,针灸组子宫内膜厚度为6.63±1.16,西药组子宫内膜厚度为6.50±1.53。经两独立样本t检验,P=0.700.05,表明两组患者治疗前子宫内膜厚度差异无统计学意义。针灸组患者自身前后对比,经配对样本t检验,t=-5.12;西药组患者自身前后对比,经配对样本t检验,t=-2.60,两组p值均0.05,差异具有统计学意义,也就是两种治疗方法均可以促进子宫内膜增长。两组患者在治疗后的子宫内膜厚度经独立样本t检验,t=-0.13,p=0.890.05,说明针灸组在改善内膜厚度方面与西药组疗效相当。治疗前两组患者排卵次数不符合正态分布,经秩和检验,p0.05,表明两组患者治疗前排卵次数差异不具有统计学意义。治疗后,经秩和检验,两组患者的排卵次数与治疗前对比,P均0.05,表明两种治疗方法均可显著改善患者的排卵情况。治疗后两组患者排卵次数比较不满足正态分布,经秩和检验。治疗后两组排卵次数比较P0.05,差异具有统计学意义,说明在增加排卵次数方面针灸组优于西药组。治疗后两组妊娠率比较采用卡方检验,P0.05,差异无统计学意义,说明治疗后两组妊娠率比较无统计学意义,两者在改善妊娠结局方面疗效相当。结论:以培土健脾为理念的针刺联合腹部以河图为理论基础的麦粒灸治疗方法在改善排卵障碍性不孕患者的抑郁状况、子宫内膜厚度、排卵数目方面及中医症候方面较单纯服用西药有优势,并且为一种安全有效的辅助受孕的方法。
[Abstract]:Objective: To observe the clinical effect of acupuncture combined with moxibustion ovulation effect, evaluation and clinical efficacy of acupuncture method in the spleen as the theoretical basis of the earth, and to explore its mechanism, to provide reference for the proof of the advantages of acupuncture combined with moxibustion ovulation, improve the endometrial thickness. Methods: 60 cases of patients using randomized controlled methods were divided into two groups, acupuncture group and Western medicine group of 30 cases, in the menstrual cycle fifth days following treatment: 1, acupuncture group: the main points: Tianshu (double), moisture, vaginal, back, Zusanli and Sanyinjiao acupoints: Qi stagnation and blood stasis and blood, Taichong; damp heat, blood deficiency and water He; cold house plus Guanyuan, Mingmen; phlegm stasis plus Yin Ling Quan, fenglong. Moxibustion abdominal operation method: take about 5mg fine moxa, made sharp, crude, sharp and flat for the placement of the AI particles about 2mmm in diameter, height of about 3mm, the corresponding point of the drug coated with medicine juice (juice moxibustion medicine juice from Hongkong Government Chemist Dr. Zhang Chaohan family), placed on the surface, the top of the column is ignited, as if, when the patients feel local burning pain, pressing the thumb nail moxa make it out, in the same way a acupoint moxibustion. To remove the residual 5min after moxibustion moxa. The painting schema theory as the theoretical basis, moxibustion points: 1 Digital moxibustion Guanyuan point moxibustion; 2 bilateral stone clearance points; 3 point moxibustion, huaroumen, Tianshu acupoint (all right); 4 points moxibustion Yangming foot huaroumen to between the acupoint (both left); 5 points moxibustion moisture, vaginal, bilateral Huangshu, Shenque acupoint not only as a symbol, 6 points moxibustion; moxibustion bilateral back, bilateral, bilateral Dahe fushe; 7 points moxibustion bilateral liangmen and bilateral Yintu, Zhongwan, liangmen and negative points point the moxibustion 1 points, 9 points 8 strong; with foot too Yin spleen, with energy-saving, energy-saving as the starting and ending, evenly distributed in the abdomen on both sides of the spleen by 10 points in the north; moxibustion big giant, four full, 1 inches below the navel, southern moxibustion Taiyi, Shang Qu 2 inches, umbilical. After the acupuncture treatment was completed immediately after the treatment of abdominal wheat grain moxibustion, treatment once every other day, continuous treatment for one month for 1 courses, a total of 3 courses of treatment. There are fifth days of retreat bleeding in oral or vaginal Clomifene Citrate Capsules menstruation, taking 50mg daily for 5 days. 2. western medicine group: oral clomiphene, usage with acupuncture group. Medication and adverse reactions were recorded during the course of treatment. The two groups were treated with 3 menstrual cycles and the treatment was completed during the treatment. Age, course of disease, TCM syndrome differentiation, endometrial thickness, SDS depression scale, ovulation frequency and pregnancy were recorded before and after treatment to evaluate the clinical efficacy. Results: there were no cases of exfoliation and elimination during the treatment of the two groups. Two groups of patients before treatment, in terms of age, course of disease, TCM syndrome differentiation, P values were greater than 0.05, the difference was not statistically significant, indicating that the two groups of patients before treatment is comparable. Before the treatment, acupuncture group SDS score was 44.63 + 11.49, western medicine group, the SDS score was 48.50 + 12.54, between the two groups by t test, the difference was not statistically significant (P=0.220.05); acupuncture group after treatment, the SDS score was 40 + 9.72, western medicine group, the SDS score was 46.27 + 9.45, the two groups after treatment with the SDS score compared with before treatment were significantly different (P0.05); comparison between the two groups after treatment SDS score had significant difference (P=0.020.05), in short, can reduce the two methods for the treatment of patients with SDS score, SDS score and acupuncture group decreased than that of Western medicine group. Before treatment, the thickness of the endometrium in the acupuncture group was 6.63 + 1.16, and the thickness of the endometrium in the western medicine group was 6.50 + 1.53. Two independent samples t test, P=0.700.05, showed that there was no significant difference in the thickness of endometrium before treatment in the two groups. The patients in the acupuncture group were compared before and after matching, paired samples t test, t=-5.12, western medicine group before and after their own contrast, paired samples t test, t=-2.60, two groups of P values were 0.05, the difference was statistically significant, that is, the two treatment methods can promote endometrial growth. The endometrial thickness of the two groups after treatment was tested by independent sample t test, t=-0.13 and p=0.890.05, indicating that the acupuncture group had the same effect as the western medicine group in improving the thickness of the endometrium. The number of ovulation in the two groups did not conform to normal distribution, and the rank sum test, P0.05, showed that there was no statistical difference in the number of ovulation in the two groups before treatment. After treatment, by rank sum test, the number of ovulation in the two groups was compared with that before treatment, P was 0.05, indicating that the two treatments could significantly improve the ovulation of the patients. After treatment, the number of ovulation in the two groups was not satisfied with normal distribution, and the rank sum test was used. After treatment, the number of ovulation in the two groups was P0.05, the difference was statistically significant, indicating that the acupuncture group was better than the western medicine group in increasing the number of ovulation. After treatment, the pregnancy rate of the two groups was compared with chi square test. There was no significant difference in P0.05 between the two groups, indicating that there was no significant difference in the pregnancy rate between the two groups after treatment. Conclusion: moxibustion therapy for spleen earth in painting as the theoretical basis of the concept of abdominal acupuncture combined with improvement in depression, anovulatory infertility patients' endometrial thickness, ovulation number and TCM syndrome compared with simple western medicine has the advantage, and is a safe and effective method of assisted conception.
【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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