本文選題：輸卵管妊娠 + 異位停方��； 參考：《南京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:運用中、西藥聯(lián)合的方法醫(yī)治未破損型輸卵管妊娠,并針對臨床治療效果加以剖析。通過觀察符合條件的臨床病例,將異位停方聯(lián)合甲氨蝶呤(MTX)應(yīng)用與單純采用MTX對病例的影響作比較,以闡明中藥聯(lián)合MTX醫(yī)治未破損型輸卵管妊娠可以獲得更佳的療效,為藥物保守性醫(yī)治異位妊娠病提供客觀的臨床研究基礎(chǔ)。方法:1.本課題所納入的研究對象共60例,均選自2015年3月至2016年10月于江蘇省中醫(yī)院婦科收住入院的未破損型輸卵管妊娠病患,中醫(yī)證型應(yīng)當(dāng)分屬氣滯血瘀證。按照隨機、單盲的原則,將要求施行藥物保守治療方案的病患劃分成觀察組、對照組,每組納進30例,通過統(tǒng)計學(xué)軟件處理,比較兩組病患的年齡分布、停經(jīng)時間、用藥前血β人絨毛膜促性腺激素(β-HCG)值、附件包塊直徑及中醫(yī)證候總積分,得知觀察組和對照組之間均不存在顯著性差別(P0.05),符合可比的條件。2.觀察組30例病患按照1mg/kg或50mg/m2(常規(guī)用量為50～75mg),單次劑量肌注MTX。在使用MTX的當(dāng)天同時給予口服中藥湯劑,每日一劑,1周當(dāng)作1個療程,總共為1～2個療程,隨訪3個月。對照組的30例病患則僅施以MTX肌注,方法同觀察組。比較兩組的臨床療效、中醫(yī)證候療效、用藥后的中醫(yī)證候積分、血β-HCG水平及其降低為陰性所需要的時間、B超檢查附件包塊消減程度以及不良反應(yīng)發(fā)生率。3.統(tǒng)計學(xué)方法所有統(tǒng)計資料均采用SPSS 21.0統(tǒng)計學(xué)軟件進行相應(yīng)的數(shù)據(jù)處理分析。計量資料以" x±s"表示,接受t檢驗,計數(shù)資料接受X2檢驗,等級資料接受秩和檢驗,以P0.05為差別有統(tǒng)計學(xué)意義。結(jié)果:1.在臨床療效方面:觀察組30例病患中有效29例,無效1例,總有效率達96.7%;對照組30例病患中有效24例,無效6例,總有效率達80.0%,比較兩組之間的臨床總有效率,表現(xiàn)為顯著性差異(P0.05)。2.在中醫(yī)證候療效方面:按照中醫(yī)證候療效的判斷界定標(biāo)準(zhǔn),觀察組30例病患中有1例痊愈,1例顯效,20例有效,8例無效,總有效率達73.3%;對照組30例病患中有0例痊愈,0例顯效,15例有效,15例無效,總有效率達50.0%,兩組之間的中醫(yī)證候療效相比較,顯現(xiàn)為顯著性差異(P0.05)。用藥后兩組中醫(yī)證候積分相比較,觀察組為5.80±2.46,對照組為7.17±1.91,顯示為顯著性差異(P0.05)。3.經(jīng)過統(tǒng)計學(xué)檢驗得知,用藥第7天時,觀察組血β-HCG降低≥15%的例數(shù)與對照組相比,存在顯著性差別(P0.05)。用藥第14天時,觀察組血β-HCG降低≥1/3的例數(shù)與對照組相比,存在顯著性差別(P0.05)。兩組血β-HCG降低為陰性所用的時間相比,存在顯著性差距(P0.05);但兩組包塊完全吸收的耗時相比,不存在顯著性差距(P0.05)。4.在藥物副作用方面:用藥后觀察組比對照組發(fā)生藥物不良反應(yīng)的例數(shù)少,并且程度較輕,療程結(jié)束后,癥狀自行好轉(zhuǎn)。結(jié)論:異位停方聯(lián)合MTX治療未破損型輸卵管妊娠協(xié)同增效,使血β-HCG迅速下降而提高殺胚能力,促進附件包塊的吸收以及縮減病程,提高了藥物保守性醫(yī)治本病的成功率。另外,觀察組較對照組二次肌注MTX者少而降低了不良反應(yīng)的發(fā)生率,且臨證加減的中藥可適當(dāng)?shù)鼐徑釳TX引起的不良反應(yīng),是一種值得推廣的藥物保守性醫(yī)治未破損型輸卵管妊娠的方法。
[Abstract]:Objective: to treat the undamaged tubal pregnancy with the combination of Western medicine and Western medicine, and to analyze the effect of clinical treatment. By observing the clinical cases, the effect of the combination of ectopic pterin combined with methotrexate (MTX) and the simple use of MTX was compared to clarify the combination of traditional Chinese medicine and MTX in the treatment of undamaged tubal pregnancy. A better therapeutic effect can be obtained to provide an objective clinical research basis for the conservative treatment of ectopic pregnancy. Methods: 60 subjects were selected from 1. subjects, all of which were selected from March 2015 to October 2016 in the Department of Gynecology of Jiangsu Province Traditional Chinese Medicine Hospital. According to the random, single blind principle, the patients were divided into the observation group and the control group, and the control group was admitted into 30 cases. The age distribution of the two groups of patients, the time of the menopause, the value of the beta human chorionic gonadotropin (beta -HCG), the diameter of the appendage mass and the total score of TCM syndrome were compared by the statistical software. There was no significant difference between the observation group and the control group (P0.05), which accords with the comparable condition.2. observation group 30 patients according to 1mg/kg or 50mg/m2 (the conventional dosage is 50 to 75mg), and the single dose of MTX. was given oral Chinese herbal decoction on the same day with MTX, one dose per day, 1 weeks as 1 courses, and a total of 1~2 courses, followed up for a total of 1~2 courses. 3 months. 30 patients in the control group were treated with only MTX muscle injection, and the methods were compared with the observation group. The clinical efficacy of the two groups, the curative effect of TCM syndrome, the score of TCM syndrome after the medication, the level of blood beta -HCG and the time that it was reduced to negative, the degree of subtracting the appendage block and the incidence of adverse reactions in the two groups were all statistical methods. SPSS 21 statistics software was used for data processing and analysis. The measurement data were expressed as "x + s", received t test, counting data received X2 test, rank data received rank sum test, and P0.05 was statistically significant. Results: 1. in clinical efficacy: 30 cases of the observation group were effective in 29 cases, and 1 cases were invalid, the total effective rate reached 96.7% of the 30 cases in the control group, 24 cases were effective and 6 cases were invalid, the total effective rate was 80%, compared with the total effective rate between the two groups, the significant difference between the two groups was compared (P0.05).2. in the TCM syndrome effect: according to the standard of judging the curative effect of TCM syndrome, 1 cases were cured in 30 cases in the observation group, 1 cases were markedly effective, 20 cases were effective, 8 cases were ineffective, total The efficiency was 73.3%, 0 of the 30 cases in the control group were cured, 0 were markedly effective, 15 cases were effective, 15 cases were invalid, the total effective rate was 50%. The difference of TCM syndromes between two groups showed significant difference (P0.05). After the use of the TCM syndrome scores of two groups, the observation group was 5.80 + 2.46, and the control group was 7.17 + 1.91, showing significant difference (P0 .05) after seventh days of statistics,.3. showed that there was a significant difference (P0.05) in the number of blood beta -HCG in the observation group as compared with the control group (P0.05). The number of blood beta -HCG in the observation group was significantly different from that of the control group at fourteenth days (P0.05). Two groups of blood beta -HCG decreased to negative time compared with the control group. There was a significant difference (P0.05), but there was no significant difference (P0.05).4. in the side effects of the total absorption of the two groups. The number of adverse drug reactions in the observation group was less than that of the control group, and the degree was lighter after the treatment. Conclusion: the ectopic stop side combined with MTX for the treatment of the undamaged type. The synergistic effect of oval tube pregnancy makes the blood beta -HCG decrease rapidly, improve the ability to kill the embryo, promote the absorption of the appendage mass and reduce the course of disease, and improve the success rate of the drug conservatism to cure the disease. In addition, the observation group is less than the control group and reduces the incidence of adverse reactions two times in the control group, and the Chinese herbal medicine with the addition and subtraction can relieve the MTX properly. The adverse reaction is a drug conservative method to treat undamaged tubal pregnancy.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.22

【參考文獻】

相關(guān)期刊論文 前10條

1 許志敏;馮志玲;;甲氨蝶呤聯(lián)合米非司酮治療異位妊娠的臨床效果[J];吉林醫(yī)學(xué);2017年02期

2 盧曄;;化瘀通絡(luò)方改善輸卵管妊娠藥物保守治療后生育能力的效果研究[J];中國婦幼保健;2015年35期

3 湯素文;;β-hCG、孕酮在監(jiān)測輸卵管妊娠保守治療中的變化研究[J];臨床醫(yī)學(xué);2015年10期

4 張旗p，

本文編號：2002060