發(fā)布時間：2018-08-02 15:09

【摘要】：目的： 探討復方米非司酮聯(lián)合清熱活血殺胚方保守治療未破裂型異位妊娠的效果，為臨床的應用提供一定的數(shù)據(jù)支持和科學依據(jù)。 方法： 選擇2012年6月-2013年9月湖北省中醫(yī)院及武漢市第一醫(yī)院婦產(chǎn)科住院部收治的56例未破裂型異位妊娠住院患者，隨機分成兩組，治療組28例采用復方米非司酮配合口服清熱活血殺胚方治療，，對照組28例采用單純復方米非司酮治療。觀察比較兩組的臨床療效、治療后血β-HCG降至正常水平所需要的時間、治療后4周盆腔包塊的直徑大小、腹痛消失時間及有生育要求者輸卵管通暢度的情況。 結果： 1.治療組28例患者有效22例，無效6例，有效率為78.57%。對照組28例患者有效15例，無效13例，有效率為53.57%。兩組有效率比較，差異具有顯著性（P0.05），治療組療效優(yōu)于對照組。 2.治療組有效者22例，治療組治療后血β-HCG降到正常水平所需要的時間為39.55±3.56d，對照組有效者15例，所需要的時間為41.53±4.00d，P0.05，說明兩組在降低血β-HCG上無明顯差異（P0.05）。 3.治療組發(fā)現(xiàn)附件包塊者19例，治療后4周附件包塊直徑大小為0.48±0.28cm；對照組發(fā)現(xiàn)附件包塊者10例，治療后4周附件包塊直徑大小為1.50±0.39cm。治療組在縮小附件包塊上效果優(yōu)于對照組，差異具有高度顯著性（P0.01)。 4.治療組腹痛患者17例，腹痛消失時間為5.71±0.92天；對照組腹痛患者10例，腹痛消失時間為10.00±1.25天。兩組在腹痛消失時間上差異具有高度顯著性（P0.01)，即治療組治療后腹痛時間較對照組短。 5.治療組有17例有生育要求，其中有3例失訪，對照組有15例有生育要求。治療組14例，左側輸卵管通暢3例，右側通暢3例，左右側均通暢者5例，不通暢者3例。對照組15例，左側輸卵管通暢2例，右側通暢1例，左右側均通暢0例，不通暢者12例。兩組在輸卵管通暢性上的比較具有顯著差異性（P0.01)，即治療組治療后輸卵管通暢性較對照組好。 結論： 復方米非司酮聯(lián)合清熱活血殺胚方治療未破裂型異位妊娠效果良好，能彌補單獨使用西藥的不足之處，使臨床療效提高，促進盆腔包塊的吸收及消散，最大限度的恢復患者的生殖功能，減輕患者的精神負擔。
[Abstract]:Objective: to explore the effect of compound mifepristone combined with Qingre Huoxue Shatian recipe for conservative treatment of unruptured ectopic pregnancy and to provide certain data and scientific basis for clinical application. Methods: from June 2012 to September 2013, 56 patients with unruptured ectopic pregnancy were randomly divided into two groups: Hubei traditional Chinese Medicine Hospital and Department of Obstetrics and Gynecology of the first Hospital of Wuhan City. The treatment group (28 cases) was treated with compound mifepristone combined with oral prescription of clearing heat and activating blood circulation to kill embryo, while the control group (28 cases) was treated with compound mifepristone alone. The clinical effects of the two groups were observed and compared. The time required for the blood 尾 -HCG to decrease to the normal level after treatment, the diameter of pelvic masses, the time of disappearance of abdominal pain and the patency of tubal tubes were observed and compared 4 weeks after treatment. Results: 1. In the treatment group, 22 cases were effective and 6 cases ineffective, the effective rate was 78.57. In the control group, 15 cases were effective and 13 cases ineffective, the effective rate was 53.57. The effective rate of the two groups was significantly higher than that of the control group (P0.05), the curative effect of the treatment group was better than that of the control group. 22 cases were effective in the treatment group, and the time required for the blood 尾 -HCG to decrease to the normal level in the treatment group was 39.55 鹵3.56 days, while that in the control group was 15 cases, and the time required was 41.53 鹵4.00 dP0.05, indicating that there was no significant difference between the two groups in reducing serum 尾 -HCG (P0.05). The diameter of adnexal mass was 0.48 鹵0.28 cm in the treatment group and 1.50 鹵0.39 cm in the control group 4 weeks after treatment. The effect of the treatment group on reducing the adnexal mass was better than that of the control group, and the difference was highly significant (P0.01). In the treatment group, 17 patients with abdominal pain disappeared for 5.71 鹵0.92 days, while the control group for 10 patients with abdominal pain, the time for the disappearance of abdominal pain was 10.00 鹵1.25 days. There was a significant difference between the two groups in the disappearance time of abdominal pain (P0.01), that is, the time of abdominal pain in the treatment group was shorter than that in the control group (P0.01). In the treatment group, 17 cases had fertility requirement, 3 cases were lost, and 15 cases in the control group. In the treatment group, there were 14 cases of tubal patency, 3 cases of left tubal patency, 3 cases of right side patency, 5 cases of left and right side patency, 3 cases of unpatency. In the control group, there were 15 cases, 2 cases of left tubal patency, 1 case of right side patency, 0 cases of left and right side patency, 12 cases of unpatency. There was significant difference between the two groups in the oviduct patency (P0.01), that is, the treatment group was better than the control group after treatment. Conclusion: compound mifepristone combined with clearing heat and activating blood circulation to kill embryo is effective in treating unruptured ectopic pregnancy, which can make up for the deficiency of western medicine alone, improve the clinical efficacy and promote the absorption and dissipation of pelvic mass. To maximize the recovery of the reproductive function of patients, reduce the mental burden of patients.
【學位授予單位】：湖北中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R714.22

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