生化汤预防剖宫产后恶露不绝的临床研究

发布时间：2018-03-28 06:35

本文选题：剖宫产　切入点：子宫复旧不全　出处：《广州中医药大学》2016年博士论文

【摘要】：目的：中国剖宫产率全球最高,并且逐年攀升。大量研究表明剖宫产后子宫复旧过程明显比顺产差。中医认为产后“瘀血内阻、多虚多瘀”是产妇的生理特点。加之手术金刃损伤胞宫,气血耗伤更重,恶露排出无力,使胞宫久泄不藏,血海不得安宁。产后恶露不绝的治疗在中国传统医学中记载颇多,其中又以生化汤为最常用方剂。本研究以剖宫产产妇为研究对象,在术后常规护理的基础上,采用随机对照的方法,从血性恶露持续时间和排出量、血液流变学、宫底下降高度以及中医证候变化等多角度评价生化汤原方比例与临床常用剂量以及不同煎煮方式下的生化汤对产妇子宫复旧的影响。方法：本研究在林嘉祈妇产科诊所收集符合纳入标准并愿意参与治疗的剖宫产足月产妇,研究从2015年3月开始,至2015年11月结束,共收入90名患者。随机分为生化汤原方组、生化汤常规剂量组各45例。纳入标准包括：1.年龄大于21岁小于40岁；2产妇分娩时孕龄大于等于37周小于42周,单胎；3剖宫产过程较顺利,术中或术后无危急重症,如大量失血、休克及子宫全切或次切等。纳入病例均进行常规剖宫产术后护理,产后第2天均开始口服生化汤,采用简单数字随机法分为两组。每组各45例。生化汤原方组：当归24g,川芎9g,桃仁14粒,炮姜1.5g,甘草1.5g。每日一剂,加黄酒200m1浸泡十分钟,煎煮,沸后20分钟,过滤,残渣加黄酒100ml煎煮,沸后10分钟,连服7天。生化汤常规剂量组：当归15g,川芎l0g,桃仁10g,炮姜10g,甘草10g。每日一剂,加清水200m1,浸泡10分钟后,煎煮一次,水沸腾后改小火煎煮20分钟,过滤,残渣加清水100ml煎煮,沸后10分钟,连服7天。观察两组治疗前后阴道血性恶露持续时间及恶露量、血液流变学、宫底下降高度、中医证候变化等。结果：1、组间均衡性本研究采用随机对照试验方法进行临床试验,共收合格患者90例。服用原方生化汤的剖宫产产妇年龄最小24岁,最大31岁,体重最轻55Kg,最重66Kg,身高最低155cm,最高168.2cm。服用常规剂量的剖宫产产妇年龄最小23岁,最大33岁,体重最轻57Kg,最重64Kg,身高最低157cm,最高167.5cm。两组患者病程差异均衡,可以继续进行后续比较(p0.05)。服用原方生化汤的剖宫产产妇的文化程度在初中及以下的有5例,高中9例,大学及以上16例；职业是家庭妇女或无业的10例,脑力劳动者15例,体力劳动者5例。服用常规剂量的剖宫产产妇的文化程度在初中及以下的有6例,高中7例,大学及以上17例；职业是家庭妇女或无业的11例,脑力劳动者16例,体力劳动者3例。两组患者差异均衡,可以继续进行后续比较(p0.05)。服用原方生化汤的剖宫产产妇中第一次怀孕的有13例,第二次怀孕的有17例；初产妇22例,已生育1次的8例。服用常规剂量的剖宫产产妇中第一次怀孕的有11例,第二次怀孕的有17例,第三次怀孕的有2例；初产妇19例,已生育1次的9例,已生育两次的有2例。两组患者差异均衡,可以继续进行后续比较(p0.05)。中医辨证分型方面：原方组收治气虚证1例,气虚血瘀40例,血热证1例,血瘀证3例；常规组收治气虚证2例,气虚血瘀38例,血热证1例,血瘀证4例。两组患者差异均衡,可以继续进行后续比较(p0.05)。服用生化汤原方的剖宫产产妇和服用常规剂量的生化汤的剖宫产产妇在治疗前全血高切相对粘度、全血低切相对粘度、血沉、红细胞压积、血浆粘度值比较均有很好的可比性(p0.05)。在中医证候积分方面,服用生化汤原方的剖宫产产妇和服用常规剂量的生化汤的剖宫产产妇在恶露、腹痛、腰酸、神疲乏力、气短懒言方面的程度一致,可以进行比较(p0.05)。2、治疗后比较服用生化汤原方的剖宫产产妇血性恶露持续天数平均为12.12±2.13天,明显较服用常规剂量的生化汤的产妇短(平均18.12±5.34天),差异经统计学检验有意义(P0.05)服用生化汤原方的剖宫产产妇血性恶露量在术后第1、3天观察时分别是162.17±27.13mi、38.13±3.01ml,和服用常规剂量的生化汤的产妇(分别是161.30±29.11mi、40.56±4.12m1)比较差异经统计学检验无意义(P0.05)；服用生化汤原方的剖宫产产妇血性恶露量在术后第5天观察时为10.29±2.58mi,明显较服用常规剂量的生化汤的产妇减少(16.31±3.40m1),差异经统计学检验有意义(P0.05)。服用生化汤原方的剖宫产产妇宫底下降比在术后第1、3天观察时和服用常规剂量的生化汤的产妇比较差异经统计学检验无意义(P0.05)；服用生化汤原方的剖宫产产妇宫底下降比在术后第5天观察时明显较服用常规剂量的生化汤的产妇多,差异经统计学检验有意义(P0.05)服用生化汤原方的剖宫产产妇和服用常规剂量的生化汤的产妇,血液流变学各项指标均较治疗前显著降低(P0.01)；在降低全血高切相对粘度、全血低切相对粘度、血沉、红细胞压积等方面,二者无显著性差异,服用生化汤原方的剖宫产产妇的血浆粘度值比服用常规剂量的生化汤的产妇更显著地降低(P0.01)。剖宫产产妇无论服用原方生化汤还是常规剂量的生化汤,恶露、腹痛、腰酸、神疲乏力、气短懒言都较服药前明显好转(P0.05)。剖宫产产妇服用生化汤原方后在恶露改善、神疲乏力、气短懒言方面比服用常规剂量更有优势(P0.05)。中医各证型治疗后总有效率比较,两组各证型总有效率均为100%,而其中仅气虚血瘀之间差异有统计学意义(P0.05),余证型差异无统计学意义。结论：1、“气虚”、“血瘀”是剖宫产产妇比较突出的中医证候特点。气虚血瘀证是剖宫产产妇常见的中医证型。2、剖宫产术后产妇服用生化汤原方的汤剂能有效预防产后恶露不绝。3、按《傅青主女科》用药比例及炮制方式煎药的产妇在血性恶露持续时间、血性恶露量、宫底下降比、血浆粘度值、中医证候(如恶露、神疲乏力、气短懒言等)改善程度比按临床常规剂量服药的产妇理想。
[Abstract]:Objective : To study the effect of traditional Chinese medicine on maternal uterus after cesarean section .
( 2 ) the gestational age of the pregnant woman is more than or equal to 37 weeks and less than 42 weeks , and the single tire ;
A randomized controlled trial was used to study the duration of vaginal bleeding , total weight , blood rheology , the height of uterine fundus , and the change of TCM syndrome . Results : 1 . The average age of cesarean section was 25 years , the weight was 55 Kg , the heaviest weight was 66 Kg , the height was 155 cm , the weight was up to 168.2 cm . The average age of caesarean section was 23 years , the maximum age was 33 years , the weight was the lightest of 57 Kg . The average height of 64 Kg , the height of 15cm and the highest 167.5 cm , the difference of the course of the two groups was balanced , and the follow - up comparison could be continued ( P < 0.05 ) . In the caesarean section , the cultural level of the pregnant woman who took the raw soup was 5 cases , 9 cases in high school , 16 cases in university and above .
The occupation is 10 cases of family women or unemployed , 15 cases of mental workers , 5 manual workers , 6 cases in junior high school and 17 cases in high school , 7 cases in high school , 17 cases in high school , and 5 cases of manual labor .
There were 11 cases of family women or unemployed , 16 cases of mental workers and 3 manual workers . The difference of the two groups was balanced , and the follow - up comparison could be continued ( P 0.05 ) . There were 13 cases of the first pregnancy in the caesarean section of the original Fang Sheng Hua Tang and 17 cases of the second pregnancy .
Among the 22 pregnant women , there were 11 cases of the first pregnancy , 17 cases of the second pregnancy and 2 cases of the third pregnancy .
In 19 cases , there were 9 cases with birth , 2 cases had been given birth twice . The difference between the two groups was balanced , and the follow - up comparison could be continued ( p < 0.05 ) . The syndrome differentiation of TCM : the original prescription group received qi deficiency syndrome in 1 case , Qi deficiency and blood stasis 40 cases , blood heat syndrome 1 case , blood stasis syndrome 3 cases ;
In the traditional Chinese medicine syndrome integration , the relative viscosity , whole blood low shear relative viscosity , blood sedimentation rate , red blood cell pressure product and plasma viscosity value were significantly higher than those in the conventional dose of Sheng Hua Tang ( P 0.05 ) .
There was no significant difference in maternal mortality ( 16.31 卤 3.40ml ) at the 5th day after operation , and the difference was statistically significant ( P0.05 ) .
There were significant differences in the maternal and blood rheology indexes ( P0.01 ) .
There was no significant difference in the relative viscosity of whole blood , the relative viscosity of whole blood , the blood sedimentation , the hematocrit and so on .

【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R271.43

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