加味寿胎丸治疗肾虚型早期先兆流产疗效观察及保胎后妊娠结局的研究

发布时间：2018-01-31 22:45

本文关键词： 早期先兆流产肾虚型加味寿胎丸保胎治疗妊娠结局　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的观察加味寿胎丸治疗肾虚型早期先兆流产的临床疗效,并对早期先兆流产患者保胎治疗后的妊娠结局进行研究。方法收集2015年4月-2016年4月在南京医科大学附属妇产医院中医科住院部行保胎治疗的肾虚型早期先兆流产患者129例,随机分为两组,其中,中西医结合保胎组66例,西药保胎组63例。西药保胎组给予口服地屈孕酮片,每次1Omg,每日3次;肌注黄体酮,每次20mg,每日1次。中西医结合保胎组在西药治疗的基础上,同时口服中药治疗,以加味寿胎丸治疗,水煎服,每日一剂,早晚温服。观察两组临床疗效及临床症候的改善情况。从临床收集的治疗病例中选取保胎后分娩的女性100例(中西医结合保胎50例,西药保胎50例)作为治疗组,另随机选取2015年4月-2016年4月在南京医科大学附属妇产医院分娩的且无早期药物保胎史的孕妇100例作为对照组,对治疗组和对照组孕妇妊娠期及分娩期并发症进行统计,包括早产、妊娠期高血压、妊娠期糖尿病(GDM)、妊娠期肝内胆汁淤积症(ICP)、胎膜早破(PROM)、胎盘粘连、前置胎盘及产后出血(PPH)等情况;同时统计新生儿身体健康情况,包括新生儿畸形、新生儿窒息(死亡)、巨大儿及低体重儿等不良结局。结果中西医结合保胎组痊愈38例,有效24例,无效4例,总有效率93.9%;西药保胎组痊愈26例,有效25例,无效12例,总有效率81%。两组疗效相比差异具有统计学意义(P0.05)。在治疗后中医症候评分方面,中西医结合保胎组优于西药保胎组,差异具有显著统计学意义(P0.01)。治疗组在妊娠期及分娩期并发症和新生儿不良结局方面与对照组相比较,除早产(P0.05)外,差异均无统计学意义(P0.05)。结论1.加味寿胎丸治疗肾虚型早期先兆流产疗效可靠,在临床疗效、改善临床症候上优于单纯西药保胎。2.有早期先兆流产史的妇女更易发生早产,且早产孕周易发生于34-37周。3.早期先兆流产保胎治疗后继续妊娠未增加妊娠期高血压、妊娠期糖尿病、妊娠期肝内胆汁淤积症、前置胎盘等妊娠期合并症的发病率。4.早期先兆流产保胎治疗后继续妊娠未增加胎膜早破、产后出血、胎盘粘连等分娩期并发症的发病率。5.早期先兆流产保胎治疗后继续妊娠未增加低体重儿、巨大儿、畸形、窒息、死亡等新生儿不良结局的发病率。
[Abstract]:Objective to observe the clinical effect of Jiawei Shoutai pill on early threatened abortion of kidney deficiency type. The pregnancy outcome of early threatened abortion patients after fetal preservation treatment was studied. Methods from April 2015 to April 2016 in the Department of traditional Chinese Medicine affiliated to Nanjing Medical University Department of Obstetrics and Gynecology Department of traditional Chinese Medicine Department of Fetal Preservation treatment of the kidney. 129 cases of early threatened abortion with deficiency type. They were divided randomly into two groups: 66 cases in the group of integrated traditional Chinese and western medicine and 63 cases in the group of keeping fetus with western medicine, and the other group was given oral diproprogesterone tablets 3 times a day, 1 Omg each time. Intramuscular injection of progesterone, 20 mg per day, once a day. The combination of traditional Chinese and Western medicine on the basis of the treatment of Western medicine, oral Chinese medicine treatment, with modified Shoutai pills treatment, water decoction, one dose per day. Morning and evening warm clothes. Observe the two groups of clinical efficacy and the improvement of clinical symptoms. From the clinical collection of cases selected from the treatment of 100 women born after fetal preservation (50 cases of integrated Chinese and Western medicine fetal preservation. 50 cases were treated with western medicine as treatment group. From April 2015 to April 2016, 100 pregnant women who had no early history of drug preservation were selected as control group, who were delivered in Department of Obstetrics and Gynecology Hospital of Nanjing Medical University from April 2015 to April 2016. The complications of pregnancy and delivery in treatment group and control group were analyzed, including premature delivery, gestational hypertension, gestational diabetes mellitus (GDMN), intrahepatic cholestasis of pregnancy (ICP). Premature rupture of membranes (Prom), placental adhesion, placenta previa and postpartum hemorrhage (PPH); At the same time, the physical health of the newborn was counted, including neonatal malformation, neonatal asphyxia (death, macrosomia and low birth weight) and other adverse outcomes. Results 38 cases were cured and 24 cases were effective in the group of integrated traditional Chinese and western medicine. 4 cases were ineffective, the total effective rate was 93.9%; 26 cases were cured, 25 cases were effective, 12 cases were ineffective, and the total effective rate was 81%. The difference between the two groups was statistically significant (P 0.05). The combination of traditional Chinese and Western medicine group is better than the Western medicine group, the difference is statistically significant. The treatment group in pregnancy and childbirth complications and neonatal adverse outcome compared with the control group. Except preterm birth (P0.05), the difference was not statistically significant (P 0.05). Conclusion 1. The effect of Jiawei Shoutai pills on early threatened abortion of kidney deficiency type is reliable, and it is effective in clinical practice. 2. The improvement of clinical symptoms is better than that of simple western medicine. 2. Women with a history of early threatened abortion are more likely to have premature delivery. And preterm gestational weeks are prone to occur in 34-37 weeks. 3. Early threatened abortion and fetal preservation treatment continued pregnancy did not increase gestational hypertension, gestational diabetes, intrahepatic cholestasis of pregnancy. Placenta previa and other complications of pregnancy incidence. 4. Early threatened abortion after fetal treatment continued pregnancy did not increase premature rupture of membranes, postpartum hemorrhage. Incidence of complications during delivery such as placenta adhesion. 5. Incidence of adverse outcomes of newborns such as low birth weight, macrosomia, malformation, asphyxia, death and so on.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R271.9

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