正文:【摘要】目的 观察补肾健脾活血中药联合西药治疗妊娠早期合并绒毛膜下血肿的先兆流产的疗效。方法 将2014年1月1日至2014年10月31日在南京市妇幼保健院中医科住院部就诊的肾虚血瘀型先兆流产患者160例,随机分为治疗组和对照组,均治疗两周。对照组给予黄体酮肌注或者地屈孕酮口服,如果出血量较多给予维生素K静滴,有明显宫缩者给予硫酸镁静滴;治疗组西药治疗方法同对照组,同时服补肾健脾活血中药方(由菟丝子、续断、桑寄生、杜仲、当归、仙鹤草、黄芩炭等组成)加减,每天1剂。在治疗期间每周复查1次彩超了解宫腔血肿面积变化情况。若阴道流血增多或者见组织物排出、彩超发现胚胎停育则停止保胎治疗。结果 治疗组痊愈例35例,显效30例,无效15例,总有效率81.25%;对照组痊愈30例,有效28例,无效22例,总有效率72.5%,治疗组疗效优于对照组,有统计学意义(P<0.05)。结论 补肾健脾活血方联合西药治疗妊娠早期合并绒毛膜下血肿的先兆流产效果明显,可以应用于伴有绒毛膜下血肿的先兆流产患者。
关键词:绒毛膜下血肿;先兆流产;补肾健脾活血中药;肾虚血瘀型;血肿面积;临床疗效
Clinical efficacy observation of combined therapy using chinese medicine of nourish kidney and strength spleen and activate the circulation of blood and western medicine for treating early threatened abortion with sub-chorionic haematoma
Liu Ting Hou Lili
1、窗体顶端
Nanjing University of Chinese Medicine,Jiangsu Nanjing 210029 china
【 abstract 】 objective to observe the curative effect of combined therapy using chinese medicine of nourish kidney and strength spleen and activate the circulation of blood and western medicine for treating early threatened abortion with sub-chorionic haematoma .Methods 160 cases of inpatient ,who will be from January 1, 2014 to October 31, 2014 in nanjing maternity and child care regionssuffer from threatened abortion, were randomly divided into treatment group and control group. All accept Two weeks treatment, control group given flexor progesterone oral or progestin intramuscular , vitamin K static drops will be given if the bleeding is more ; Treatment group with the western medicine treatment as control group, while taking the chinese medicine of nourish kidney and strength spleen and activate the circulation of blood to add and subtrac,suchastusizi(dodder),xuduan(tsasel),sangjisheng(mistletoe),duzhong(eucommia),danggui(
angelica),xianhecao(agrimony),huangqintan(skullcapcharcoal) etc, daily 1 agent. During treatment a week later a second ultrasound intrauterine hematoma area to understand the changes.If increased vaginal bleeding or discharge, see organizational matter, ultrasound found embryos stop
第一作者:刘婷(1989-),女,汉族,河南,在读硕士研究生,研究方向:妇科生殖内分泌
通讯作者:侯莉莉(1973-),女,汉族,河北,主任中医师,研究方向:妇科生殖内分
education miscarriage treatment is stopped.Results Treatment of patients were cured 35 cases,
effective in 30 cases, 15 cases ineffective, the total efficiency of 81.25%; control group cured 30 cases, effective 28 cases, 22 cases ineffective, the total efficiency of 72.5%, the treatment group is better than the control group, but not statistically significant (P> 0.05). Conclusions the curative effect of combined therapy using chinese medicine of nourish kidney and strength spleen and activate the circulation of blood and western medicine for treating early threatened abortion with sub-chorionic bleeding is obvious can be applied to accompanied by chorionic hemorrhage patients with threatened abortion.
【Keywords】 sub-chorionic haematoma,threatened abortion,chinese medicine of nourish kidney and strength spleen and activate the circulation of blood,kidney deficiency and blood stasis,intrauterine hematoma area,Clinical efficacy
自然流产是妊娠期间的一种常见疾病,多发生于妊娠早期。先兆流产是流产发展过程当中的一种常见临床类型,主要以阴道流血伴或不伴腹痛腰酸为主要症状。绒毛膜下出血是先兆流产患者的一个常见病症,在临床上发生率比较高。合并绒毛膜下血肿的先兆流产在症状上主要以肾虚血瘀型为多,中医运用补肾健脾活血之法治疗绒毛膜下血肿具有良好的临床疗效,本文现总结如下。
临床资料
1.1 一般资料。选取自2014年1月1日至2014年10月31日在南京市妇幼保健院中医科住院部就诊的先兆流产患者160例,随机分为治疗组和对照组。治疗组与对照组在年龄、孕周、初始血肿面积及病程上两组各项指标之间比较无统计学差异((P>0.05)。
表1 一般资料
年龄(岁) 孕周(周) 初始血肿面积(长*宽) 病程(天)
治疗组 29.19±3.80 64.11±1.79 5.74±4.87 8.23±3.45
对照组 29.63±3.88 62.20±1.91 4.88±4.96 9.12±3.23
1.2 纳入标准。临床表现:参照《妇产科学》八版教材:妊娠28周前出现少量阴道流血,暗红色或者血性白带,未见妊娠物排出,阵发性下腹痛或腰背痛。妇科检查宫颈口未开、胎膜未破,子宫大小与停经周数相符,妊娠可以继续[1];‚妇科彩超见宫内胚胎存活、孕囊周围或者宫腔见液性暗区可诊断为绒毛膜下血肿;ƒ中医肾虚血瘀型辩证包含以下症状:腰酸、小腹下坠感,阴道流血色暗红,舌质偏暗或有瘀点,苔薄,脉沉细滑或沉涩。
1.3 剔除标准。1、夫妻双方染色体发现异常者2、不能排除异位妊娠或滋养细胞疾病者 3、合并有心、肝、肾等重要器官和其他系统严重的原发性疾病患者4、排除阴道炎、宫颈炎性疾病导致的出血5、生殖系统畸形6、凝血功能异常。
2、治疗方法。两组均治疗两周时间。对照组给予黄体酮40mg肌注,每天一次或者地屈孕酮10mg口服,每八小时一次,如果出血量较多给予维生素K1静滴;治疗组西药治疗方法同对照组,同时服补肾健脾活血中药方(黄芪20g,仙鹤草30g,炒白术15g,升麻6g,续断15g,当归6g,炒白芍15g,苎麻根20g,菟丝子20g,桑寄生15g,杜仲10g 黄芩炭10g炙甘草6g)加减,每天1剂,均由本院中药房煎成250ml的水剂,分早晚两次服。在治疗期间每星期复查1次彩超了解胚胎及宫腔内绒毛膜下血肿变化情况,同时嘱咐患者注意休息,条畅情志,保持外阴清洁。若阴道流血增多或者见组织物排出、彩超发现胚胎停育则停止保胎治疗。
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