本文關(guān)鍵詞：262例絕經(jīng)女性臨床資料及激素治療效果分析　出處：《重慶醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 絕經(jīng) 絕經(jīng)激素治療 陰道健康評(píng)分 SF-36生活質(zhì)量評(píng)分

【摘要】：目的:總結(jié)分析女性絕經(jīng)后相關(guān)癥狀,觀察使用絕經(jīng)激素治療(Menopausal hormone therapy,MHT)對(duì)女性絕經(jīng)后相關(guān)癥狀的控制和對(duì)血壓、血脂、骨密度及頸動(dòng)脈內(nèi)-中膜厚度的改變,研究MHT對(duì)改善血脂代謝水平、改善陰道微環(huán)境、預(yù)防骨質(zhì)疏松及提高生活質(zhì)量的影響。方法:選取2014年1月-2015年8月在重慶醫(yī)科大學(xué)附屬第二醫(yī)院婦科更年期門診就診的絕經(jīng)患者,通過(guò)詢問(wèn)病史了解病情,并進(jìn)行必要的輔助檢查,整理后分析女性絕經(jīng)相關(guān)癥狀,選取有MHT適應(yīng)癥患者,排除禁忌癥,告知患者M(jìn)HT使用利弊后自愿選擇MHT,根據(jù)患者病情給予個(gè)體化MHT方案,共有262例患者堅(jiān)持完成連續(xù)使用6個(gè)月MHT。于治療前及治療后第1、3、6個(gè)月測(cè)定患者子宮內(nèi)膜、Kupperman改良評(píng)分;于治療前及治療后6個(gè)月測(cè)定患者血壓、體重指數(shù)(Body Mass Index,BMI)、血清促卵泡生成激素(follicle stimulating hormone,FSH)、雌二醇(Estradiol,E2)、總膽固醇(Total Cholesterol,TC)、甘油三酯(Triglyceride,TG)、高密度脂蛋白(High density lipoprotein,HDL)、低密度脂蛋白(Low density lipoprotein,LDL)、骨密度(Bone mineral density,BMD)、頸動(dòng)脈內(nèi)-中膜厚度(Carotid intima-media thickness,CIMT)、陰道健康評(píng)分、sf-36生活質(zhì)量評(píng)分,進(jìn)行對(duì)比分析。安全性評(píng)估采取比較治療前后患者子宮內(nèi)膜厚度的變化,隨訪乳腺彩超,記錄治療期間不良反應(yīng)的發(fā)生及處理方式和結(jié)果。結(jié)果:1.女性絕經(jīng)后相關(guān)癥狀多種多樣,發(fā)生率最高的依次為疲乏(58.40%,153/262),性生活障礙(57.25%,150/262)、情緒異常(54.96%,144/262)、肌肉骨關(guān)節(jié)痛(54.58%,143/262)、潮熱出汗(53.44%,140/262)、睡眠障礙(51.15%,134/262)。2.絕經(jīng)女性經(jīng)mht6月后血壓、kupperman改良評(píng)分和血清fsh、ldl水平明顯下降(p0.05),差異有統(tǒng)計(jì)學(xué)意義;血清e(cuò)2、hdl水平、股骨頸bmd、陰道健康評(píng)分、sf-36生活質(zhì)量評(píng)分明顯增加,p0.05,差異有統(tǒng)計(jì)學(xué)意義;體重、bmi、tc、tg、cimt有下降趨勢(shì),腰椎bmd有增加趨勢(shì),但p0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義。3.安全性評(píng)估及不良反應(yīng)情況,治療前后子宮內(nèi)膜有輕微增厚趨勢(shì),但p0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義;隨訪乳腺彩超治療前后無(wú)明顯改變。治療過(guò)程中有28例(10.68%,28/262)患者出現(xiàn)乳房脹痛,42例(16.03%,42/262)用藥后陰道點(diǎn)滴出血,隨著治療繼續(xù)進(jìn)行,這些不良反應(yīng)均自行緩解,無(wú)其它特殊不良反應(yīng)發(fā)生。結(jié)論:女性進(jìn)入絕經(jīng)期后,雌激素水平處于低下?tīng)顟B(tài),出現(xiàn)各種絕經(jīng)相關(guān)癥狀,其癥狀的復(fù)雜性導(dǎo)致易誤診、漏診。女性絕經(jīng)后癥狀與圍絕經(jīng)期癥狀臨床表現(xiàn)有一定差異。使用mht可減輕女性絕經(jīng)相關(guān)癥狀,一定程度上改善血脂代謝水平及陰道微環(huán)境,預(yù)防骨質(zhì)疏松等,提高女性絕經(jīng)后的生活質(zhì)量和健康水平。
[Abstract]:Objective: To summarize and analyze the related symptoms in postmenopausal women, postmenopausal hormone therapy use observation (Menopausal hormone, therapy, MHT) to control the symptoms of postmenopausal women and on blood pressure, blood lipid, bone mineral density and carotid artery intima-media thickness changes of MHT on lipid metabolism level, improve the effect of vaginal micro environment and prevention osteoporosis and improve the quality of life. Methods: from January 2014 August -2015 in Second Hospital Affiliated to Chongqing Medical University outpatient gynecological patients with menopause menopause, the history to understand the disease, and the necessary auxiliary examinations, analysis of menopause related symptoms after finishing, selection of indication for MHT patients, exclusion of contraindications, inform patients of MHT using the pros and cons of voluntary choice MHT, given the individual MHT scheme according to the condition of patients, a total of 262 patients completed 6 months of continuous use MHT. Before and after treatment for first, third, sixth months, determination of the endometrium of patients with Kupperman score; to measure blood pressure and body mass index of patients before treatment and 6 months after treatment (Body Mass Index, BMI), serum follicle stimulating hormone (follicle stimulating, hormone, FSH), estradiol (Estradiol, E2), total cholesterol (Total Cholesterol TC), triglyceride (Triglyceride, TG), high density lipoprotein (High density, lipoprotein, HDL), low density lipoprotein (Low density, lipoprotein, LDL), bone mineral density (Bone mineral density, BMD), carotid artery intima-media thickness (Carotid intima-media, thickness, CIMT), vaginal SF-36 health score, life quality score, comparative analysis. Safety assessment was conducted to compare the changes of endometrial thickness before and after treatment, followed by breast color Doppler ultrasound, and recorded the occurrence and treatment of adverse reactions during treatment. Results: 1. women after menopause related symptoms varied, the highest incidence were fatigue (58.40%, 153/262), sexual disorder (57.25%, 150/262) and mood disorders (54.96%, 144/262), musculoskeletal pain (54.58%, 143/262), sweating (53.44%, 140/262), sleep disorders (51.15%. 134/262). 2. postmenopausal women with mht6 months after the blood pressure, Kupperman score and serum FSH, LDL levels were significantly decreased (P0.05), the difference was statistically significant; the serum levels of E2, HDL, BMD of the femoral neck and vaginal health score, life quality score of SF-36 was significantly increased, P0.05, the difference was statistically significant; body weight, BMI, TC, TG and CIMT decreased, lumbar BMD increased, but P0.05, the difference was not statistically significant. 3., safety assessment and adverse reactions. There was a slight thickening trend of endometrium before and after treatment, but there was no significant difference in P0.05. During treatment, 28 cases (10.68%, 28/262) had breast distention and 42 cases (16.03%, 42/262) had bleeding after vaginal administration. With the treatment continuing, these adverse reactions were relieved spontaneously, and no other special adverse reactions occurred. Conclusion: after women enter the menopause, the level of estrogen is in a low state, and there are various menopause related symptoms. The complexity of the symptoms leads to misdiagnosis and missed diagnosis. There are certain differences between the symptoms of postmenopausal women and the clinical manifestations of perimenopausal symptoms. The use of MHT can reduce the symptoms of menopausal women, to a certain extent, improve the level of lipid metabolism and vaginal microenvironment, prevent osteoporosis, and improve the quality of life and health of women after menopause.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R711

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