补肾化瘀方预防IUA术后再粘连疗效观察及IUA危险因素分析

发布时间：2018-07-20 21:45

【摘要】：目的：本课题通过流行病学调查初步探讨珠三角地区引起宫腔粘连(Intrauterine Adhesion, IUA)的可能相关危险因素。并且运用妇科经验方补肾化瘀方联合宫腔粘连分离术治疗宫腔粘连所致的月经过少甚则闭经的相关症状,观察本方药对预防宫腔粘连患者经TCRA术后再发生粘连的临床疗效。方法：1.纳入2014年6月至2016年1月于我院住院且符合宫腔粘连诊断标准的病例148例,同时期至我院体检的正常健康女性84例选为健康对照组。通过自行设计的宫腔粘连危险因素流行病学问卷进行调查,对两组人群的基线资料、生活习惯、饮食习惯、心理情志因素、孕产史、妇科疾病史、子宫体积大小等各因素进行记录、数据管理及统计分析。2.按照西医和中医(肾虚血瘀型)的诊断标准,于2014年6月1日-2016年1月1日间在我院住院病人选择合格受试者的42例患者按照临床简单随机对照试验分为两组,进行前瞻性观察研究：①对照组22例：TCRA术后上节育环,联合补佳乐(2mgbid 21天)+达芙通(10mg bid后10天)；②治疗组20例：在对照组的基础上加服补肾化瘀方中药(每日1剂,经期停服)。分别治疗3个月经周期。治疗过程中,通过对治疗前后中医证候评分、宫腔粘连评分和B超监测的子宫内膜厚度及不良反应进行临床观察,评价药物的有效性及安全性。结果：1.宫腔粘连危险因素研究结果：通过问卷调查表发放方式,采用卡方检验、t检验、二元逐步Logistic回归分析,单因素分析显示宫腔粘连的发生与年龄、焦虑、急躁、嗜食辛辣、经期吃寒凉食物、熬夜、经期行房、运动、经期保暖、孕次、产次、人流、宫腔操作次数、妇科炎性疾病、首次性生活年龄、子宫体积大小存在相关性,与身高、体重、BMI、婚姻情况、文化程度、收入情况、忧思、抑郁、经期吃水果、刻意节食、自然流产次、药流次数、器质性病变、避孕方式无相关性；将单因素分析中存在相关性的因素重新进行逐步Logistic回归模型多因素分析,显示经期吃寒凉食物、焦虑、熬夜、经期行房、孕次、人流次数、宫腔操作次数、子宫体积大小、妇科炎性疾病与宫腔粘连呈正相关,考虑为宫腔粘连发病的独立危险因素。2.补肾化瘀方预防宫腔粘连术后再粘连临床疗效结果：(1)中医整体疗效比较,治疗组总有效率为95%,对照组86.4%,经检验治疗组疗效优于对照组。组内治疗前后比较差异有统计学意义(P0.05),提示两组疗后证候疗效较疗前改善。组间比较经独立样本t检验,第1周期两组积分无差异(P0.05),治疗第2、3周期两组积分差异有显著性意义(P0.05),提示治疗组对证候的改善优于对照组。(2)治疗组在中医主症的经量及经色质方面的治疗总有效率分别为95%、94.74%,对照组分别为83.33%、75%,经检验差异有统计学意义(P0.05)；两组的月经经行时间差异无统计学意义。(3)IUA评分两组治疗前后比较差异有统计学意义(P0.05),说明两组治疗方案对宫腔粘连术后再粘连均有效,治疗后两组间IUA评分对比及两组治疗前后IUA评分差值比较,差异均有统计学意义(P0.05),提示联合中药治疗组预防再粘连疗效更显著。(4)治疗后两组患者B超内膜厚度与治疗前比较差异有统计学意义(P0.05),治疗后组间内膜厚度比较及两组治疗前后内膜厚度差值比较差异无统计学意义(P0.05),提示两组治疗方案对改善内膜增厚疗效相当。结论：初步了解到与宫腔粘连的发病可能相关的因素有经期吃寒凉食物、焦虑、熬夜、经期行房、孕次、人流次数、宫腔操作次数、子宫大小、妇科炎性疾病,其中情志方面的焦虑、人流次数、宫腔操作次数及妇科炎性疾病为高发危险因素。补肾化瘀方能够有效地预防宫腔粘连松解术后再粘连,能够更好地改善月经的经量和色质,总而言之,补肾化瘀方是安全有效的,值得推广。
[Abstract]:Objective: To investigate the possible risk factors of Intrauterine Adhesion (IUA) in the Pearl River Delta region by epidemiological investigation, and to observe the related symptoms of less menstrual amenorrhea caused by intrauterine adhesions in the treatment of intrauterine adhesions by gynecologic experience. The clinical effect of preventing adhesions in patients with intrauterine adhesions after TCRA. Methods: 1.: 148 cases were hospitalized in our hospital from June 2014 to January 2016 and conformed to the diagnostic criteria of intrauterine adhesions. 84 normal healthy women at the same time to our hospital were selected as the healthy control group. The risk factors of intrauterine adhesions were designed by ourselves. A questionnaire was conducted to record the baseline data, living habits, dietary habits, psychological factors, pregnancy history, gynecologic disease history, and the size of the uterus in two groups of people. Data management and statistical analysis of.2. were in accordance with the diagnostic criteria of Western medicine and traditional Chinese medicine (kidney deficiency and blood stasis) in January, June 1, 2014, and 1 days in January. 42 cases of hospitalized patients selected qualified subjects were divided into two groups according to the clinical simple randomized controlled trial. There were 22 cases in the control group: 22 cases in the control group: after TCRA, combined with 2mgbid (21 days) + Duff (10 days after 10mg bid); and (2) the treatment group 20 cases were added to the control group on the basis of the kidney and Huayu Prescription. Chinese medicine (1 doses per day, menstrual stop). Treatment of 3 menstrual cycles respectively. In the course of treatment, clinical observation of TCM syndrome scores, uterine adhesion score, endometrial thickness and adverse reactions monitored by B ultrasonic examination, evaluation of the efficacy and safety of drugs. Results of study on the risk factors of 1. intrauterine adhesions: through inquiry Method of questionnaire survey, using chi square test, t test, two yuan gradually Logistic regression analysis, single factor analysis showed the occurrence of uterine adhesion and age, anxiety, irritability, hot food, eating cold food, stay up late, menstrual room, exercise, menstrual warm, pregnancy, birth, abortion, uterine operation times, gynecologic inflammatory diseases, the first sex Living age, the size of the uterus was related, with height, weight, BMI, marital status, educational level, income, anxiety, depression, eating fruit, deliberate dieting, spontaneous abortion, drug flow times, organic diseases, contraceptive methods, and the correlation factors in the single factor analysis were re carried out in the progressive Logistic regression model. Model multi factor analysis showed that eating cold and cold food, anxiety, staying up late, menstrual travel, pregnancy times, number of people, uterine cavity operation times, uterus size, gynecological inflammatory disease and uterine adhesion are positively related, considering the independent risk factor of intrauterine adhesion,.2. tonifying kidney and removing blood stasis to prevent adhesion after uterine cavity adhesion clinical curative effect results: 1) the overall curative effect of traditional Chinese medicine was compared, the total effective rate of the treatment group was 95%, the control group was 86.4%, the curative effect of the treatment group was better than the control group. The difference in the treatment group was statistically significant before and after the treatment (P0.05), suggesting that the curative effect of the two groups was better than that before the treatment. The group was compared with the independent sample t test, the first cycle two groups had no difference (P0.05), and the treatment of the third group. There were significant differences between the two groups of the period (P0.05), suggesting that the improvement of the syndrome in the treatment group was better than the control group. (2) the total effective rate of treatment in the treatment group was 95%, 94.74%, and the control group was 83.33%, 75% respectively, and the difference was statistically significant (P0.05) in the control group, and the menstrual period difference between the two groups was different. There was no statistical significance. (3) there was a significant difference between the two groups of IUA scores before and after treatment (P0.05), indicating that the two groups of treatment schemes were effective for postoperative adhesions after intrauterine adhesions, and the difference between the two groups after the treatment and the difference values of the two groups before and after the treatment of the two groups were statistically significant (P0.05), suggesting that the combined Chinese medicine treatment group could prevent the recurrence. The effect of adhesion was more significant. (4) there was a significant difference in the thickness of the endometrium in the two groups after treatment (P0.05). The comparison of the thickness of the endometrium between the groups after treatment and the difference of the thickness of the endometrium between the two groups before and after treatment was not statistically significant (P0.05), suggesting that the curative effect of the treatment regimen in the two groups was equivalent to the improvement of the intimal thickening. Conclusion: preliminary conclusion: The factors that may be related to the pathogenesis of adhesion to the uterine cavity include eating cold and cold food, anxiety, staying up late, menstrual travel, pregnancy times, number of people, uterine cavity operation times, uterus size, gynecological inflammatory disease, anxiety of the womb, number of people, times of human flow, times of uterine cavity operation and inflammatory diseases of gynecology. Effective prevention of adhesions after uterine cavity adhesions can better improve menstrual volume and color quality. In a word, it is safe and effective to make up the kidney and removing stasis. It is worth promoting.
【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】：2016
【分类号】：R271.9

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