本文選題：補(bǔ)腎祛瘀法 + 子宮內(nèi)膜異位癥��； 參考：《福建中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的觀察補(bǔ)腎祛瘀法對子宮內(nèi)膜異位癥腹腔鏡術(shù)后證屬腎虛血瘀證患者的治療作用及其防治術(shù)后應(yīng)用GnRH-a致血管舒縮綜合征的臨床療效,為其臨床應(yīng)用提供科學(xué)依據(jù),增加患者對GnRH-a的耐受性,提高其治療效果,減少內(nèi)異癥腹腔鏡術(shù)后應(yīng)用GnRH-a引起的血管舒縮綜合征的發(fā)生。方法選取2015年7月至2016年12月在福建中醫(yī)藥大學(xué)附屬人民醫(yī)院婦科病房住院的腹腔鏡術(shù)后確診為EMT、應(yīng)用GnRH-a治療、證屬腎虛血瘀證的患者60例,隨機(jī)分為實(shí)驗(yàn)組、對照組,每組各30例,實(shí)驗(yàn)組采用中藥治療,選方補(bǔ)腎祛瘀方,術(shù)后從注射醋酸亮丙瑞林后第1天起服藥,每日一劑,一劑2包,早、晚各1包,餐后半小時(shí)沖服,每療程口服21天,共治療三個(gè)療程。對照組皮下注射醋酸亮丙瑞林,共三針,不予其他處理。若患者血管舒縮綜合征癥狀明顯,予谷維素口服,一次1片,一日3次。于注射第3針后的28天進(jìn)行療效評估,觀察兩組患者治療前后腎、血瘀積分及分級的改變情況,觀察兩組患者血管舒縮綜合征的發(fā)生情況及E2、FSH的變化,并對數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果1.治療前兩組腎、血瘀積分及分級無顯著性差異(P0.05),治療后實(shí)驗(yàn)組腎積分及分級較治療前降低(P0.05),對照組腎積分及分級較治療前升高(P0.05)。治療后兩組血瘀積分及分級均較治療前降低(P0.05),且實(shí)驗(yàn)組血瘀積分及分級較對照組低(P0.05)。2.治療前兩組E2、FSH水平無顯著性差異(P0.05),治療后兩組E2、FSH水平均較治療前下降(P0.05),但兩組治療后E2、FSH水平差異無統(tǒng)計(jì)學(xué)意義(P0.05)。3.治療前兩組患者均無血管舒縮綜合征的發(fā)生,治療后實(shí)驗(yàn)組出現(xiàn)陣發(fā)性烘熱、潮紅、汗出、心悸的例數(shù)及血管舒縮綜合征得分均較對照組低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1.腹腔鏡術(shù)后確診為EMT、證屬腎虛血瘀證的患者,應(yīng)用GnRH-a治療,易加劇其腎虛程度,患者術(shù)中局部血瘀程度改善,但手術(shù)血絡(luò)損傷,必然疲血未凈,補(bǔ)腎祛瘀法可通過降低腎積分及分級,改善血瘀積分及分級起到治療作用。2.在GnRH-a的作用下患者體內(nèi)的E2、FSH水平會(huì)下降,繼而出現(xiàn)低雌激素狀態(tài)相關(guān)的血管舒縮癥狀,補(bǔ)腎祛瘀法在防治EMT腹腔鏡術(shù)后應(yīng)用GnRH-a致血管舒縮綜合征方面有一定的療效,其可不通過改變E2、FSH水平而改善血管舒縮癥狀。
[Abstract]:Objective to observe the therapeutic effect of tonifying kidney and removing blood stasis method on patients with renal deficiency and blood stasis syndrome after laparoscopic operation of endometriosis and to provide scientific basis for clinical application of GnRH-a in the prevention and treatment of vasomotor syndrome. To increase the patient's tolerance to GnRH-a, improve the therapeutic effect and reduce the incidence of vasomotor syndrome caused by GnRH-a after endoscopical laparoscopy. Methods from July 2015 to December 2016, 60 patients diagnosed by laparoscopy in gynecological ward of people's Hospital affiliated to Fujian University of traditional Chinese Medicine were randomly divided into experimental group and control group. 60 patients with kidney deficiency and blood stasis syndrome were treated with GnRH-a. There were 30 cases in each group, the experimental group was treated with traditional Chinese medicine, and the prescription of tonifying kidney and removing blood stasis was selected. After the operation, one dose, two packets, one packet each, one pack early and one packet late, was taken from the first day after injection of Leuprorelin Acetate, and the oral dose was taken orally for 21 days after meal, half an hour after meal. There were three courses of treatment. The control group was subcutaneously injected with Leuprorelin Acetate for three injections without any other treatment. If the symptoms of vasomotor syndrome are obvious, oryzanol is given orally, 1 tablet once, 3 times a day. The therapeutic effect was evaluated 28 days after the third injection. The changes of renal, blood stasis score and grading were observed before and after treatment, and the occurrence of vasomotor syndrome and the changes of E2FSH in the two groups were observed. The data were analyzed statistically. Result 1. There was no significant difference in renal blood stasis score and grade between the two groups before treatment. After treatment, the renal score and grade in the experimental group were lower than that before treatment, while the renal score and grade in the control group were higher than those before treatment. After treatment, the blood stasis score and grade of the two groups were lower than that before treatment, and the blood stasis score and grading of the experimental group were lower than that of the control group. There was no significant difference in the level of E2FSH between the two groups before and after treatment. After treatment, the level of E2FSH in the two groups was lower than that before treatment (P0.05), but there was no significant difference in the level of E2FSH between the two groups after treatment. There was no vasomotor syndrome in the two groups before treatment. After treatment, paroxysmal heat, flashes, sweating, palpitation and the score of vasomotor syndrome in the experimental group were lower than those in the control group (P 0.05). Conclusion 1. The patients who were diagnosed as EMT after laparoscopy and were diagnosed as kidney deficiency and blood stasis syndrome were treated with GnRH-a. The degree of kidney deficiency was easily aggravated and the degree of local blood stasis was improved during the operation. However, the injury of blood collaterals in operation was bound to lead to no net depletion of blood. The method of tonifying kidney and removing blood stasis can improve blood stasis score and grade by reducing renal integral and grading. Under the action of GnRH-a, the level of E2FSH in patients will decrease, and then there will be vasomotor symptoms associated with low estrogen status. The method of tonifying kidney and removing blood stasis has a certain curative effect in preventing and treating vasomotor syndrome caused by GnRH-a after EMT laparoscopy. It can improve vasomotor symptoms without changing E _ 2 FSH levels.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R713

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