补肾祛瘀法治疗早期先兆流产的疗效观察及血清Ca125水平对其预后的判断价值

发布时间：2018-06-27 07:48

本文选题：早期先兆流产 + 补肾活血方　；参考：《黑龙江中医药大学》2017年硕士论文

【摘要】：目的:本课题是以肾虚血瘀型早期先兆流产的妊妇为观察对象,通过动态观察用药过程中,患者治疗前后临床症状的变化及血清人绒毛膜促性腺激素(β-HCG)水平、孕酮(P)、雌二醇(E2)及盆腔彩超的情况,以此来评估地屈孕酮联合补肾活血方治疗肾虚血瘀型早期先兆流产的临床治疗效果;连续监测怀孕初期血清Ca125的水平,通过它的变化,来探求其在早期先兆流产时的变化规律,探析血清Ca125的水平升高在判断早期前兆流产妊娠结局中的诊断价值。方法:选择符合肾虚血瘀型早期先兆流产诊断标准的患者40例,给予西药地屈孕酮10mg,日三次口服,同时配合中药补肾活血方口服,3周为一个疗程,观察患者治疗前后临床症状的改善情况,通过动态监测血清P、E2、β-HCG水平变化,盆腔彩超来观察胚胎发育情况,同时监测血清Ca125的动态水平变化,观察它在孕期的变化规律,及其与妊娠结局的关系。结果:1、经治疗后,40例临床患者临床疗效如下:痊愈5例(12.5%),显效26例(65%),有效5例(12.5%),无效4例(10%),总有效率90%。2、治疗前后患者的各个临床症候、病情程度、症候积分的对比,P值均小于0.05,说明治疗前后具有显著性差别,患者的临床均得到了明显的改善。3、经χ2检验,患者既往流产次数与临床的综合疗效存在相关性(P0.05),提示流产的次数越多,患者的治疗效果越差。4、患者妊娠后阴道出血时间与临床的综合疗效存在相关性(P0.05),阴道出血时间越短,患者治疗效果越好。5、患者治疗前后病情程度与综合疗效存在相关性(P0.05),患者病情越轻,患者治疗效果越好。6、治疗后血清P、E2、β-HCG均有不同程度变化,继续妊娠者治疗前后激素水平相比上升明显,妊娠失败组治疗前后相比上升不明显甚至有所下降。7、孕早期出现先兆流产症状的孕妇血清Ca125均有不同程度的升高,经治疗后,继续妊娠者血清Ca125水平下降明显,与治疗前具有显著性差异(P0.05),而妊娠失败者血清Ca125水平与治疗前相比下降不明显甚至有所上升。8、经方差分析,有阴道出血症状的患者血清Ca125水平升高较无阴道出血的患者明显,且出血时间越长,血清Ca125水平升高越明显(p0.001)。结论:1、地屈孕酮联合补肾活血方能够有效治疗肾虚血瘀型早期先兆流产,能明显改善阴道流血、腰酸胀痛,腹痛等临床症状,保胎效果显著。2、动态监测血清Ca125水平变化,对于早期先兆流产的风险评估有一定的临床参考价值。
[Abstract]:Objective: To evaluate the changes of clinical symptoms and serum human chorionic gonadotropin (beta -HCG) levels, progesterone (P), estradiol (E2) and pelvic color Doppler before and after the treatment of pregnant women with Early Threatened Abortion of kidney deficiency and blood stasis, and evaluate the combination of progesterone (P), estradiol (E2) and pelvic cavity color Doppler. The clinical treatment effect of the Early Threatened Abortion of kidney deficiency and blood stasis type, the level of serum Ca125 in the early stage of pregnancy was continuously monitored, and the change of it was used to explore the changes in the early threatened abortion, and to explore the diagnostic value of the level of serum Ca125 in judging the outcome of Early Threatened Abortion pregnancy. 40 cases of the diagnosis standard of Early Threatened Abortion of blood stasis were given to 40 cases of Western medicine, three times on daily oral administration of tonifying kidney and activating blood, 3 weeks as a course of treatment. The improvement of clinical symptoms before and after treatment was observed. The changes of serum P, E2, beta -HCG and pelvic color Doppler ultrasound were used to observe the development of embryo. The changes in the dynamic level of serum Ca125 were monitored and the relationship between the changes in pregnancy and pregnancy outcome was observed. Results: 1, after treatment, the clinical effects of 40 patients were cured as follows: 5 cases (12.5%), 26 cases (65%), 5 effective (12.5%), 4 cases (10%), total effective rate of 90%.2, all clinical symptoms before and after treatment, the condition of the patients before and after treatment, the condition of the patients, the condition of the patients before and after treatment, the condition of the patients before and after treatment, the condition of the patients before and after treatment, the condition of the patients before and after treatment, the condition of the patients before and after treatment, the condition of the patients before and after treatment, the condition of the patients before and after treatment, the condition of the patients before and after treatment, the condition of the patients before and after treatment, the condition of the patients before and after treatment, the condition of the patients before and after treatment, the condition of the patients before and after treatment, the condition of the patients before and after treatment, and the condition of the patients before and after treatment. Degree, syndrome score comparison, P value is less than 0.05, indicating a significant difference before and after treatment, the patient's clinical has been significantly improved.3, the x 2 test, the number of previous miscarriages in patients with the clinical comprehensive effect has a correlation (P0.05), the more the number of abortion, the more poor treatment of the patient.4, the patient vagina after pregnancy out of the vagina There is a correlation between the blood time and the comprehensive clinical effect (P0.05). The shorter the vaginal bleeding time, the better the treatment effect of the patients.5, the patient's condition degree and the comprehensive effect before and after treatment (P0.05), the less the patient's condition, the better the treatment effect of the patient.6, after the treatment, the blood clear P, E2, beta -HCG all have different degree changes, continue the pregnancy before the treatment of the patients before treatment. Compared with the increase of post hormone levels, the increase of the serum Ca125 in pregnant women with threatened abortion in the early pregnancy was.7, and the serum Ca125 level of the pregnant women in the early pregnancy was significantly lower than that before the treatment (P0.05). The level of serum Ca125 in the patients was not obvious or even higher than that before the treatment. After the analysis of variance, the level of serum Ca125 in patients with vaginal bleeding symptoms was higher than those without vaginal bleeding, and the longer the bleeding time was, the higher the level of serum Ca125 increased (p0.001). 1, the combination of progesterone and kidney invigorating blood can be effectively treated. The early threatened abortion with kidney deficiency and blood stasis can obviously improve the clinical symptoms such as vaginal bleeding, low back distention and pain, abdominal pain and so on. The effect of fetal protection is.2, and the change of serum Ca125 level is monitored dynamically. It has certain clinical reference value for the risk assessment of early threatened abortion.
【学位授予单位】：黑龙江中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R271.9

【参考文献】