【摘要】：目的本研究的目的是通過(guò)對(duì)補(bǔ)腎益氣和血法中藥介入不孕患者IVF-ET治療過(guò)程,評(píng)價(jià)補(bǔ)腎益氣和血法中藥改善IVF-ET婦女子宮內(nèi)膜和子宮血流狀態(tài)的效果。方法本研究將60例輸卵管性不孕IVF-ET患者隨機(jī)分為中藥組(30例)和對(duì)照組(30例),治療方法中藥組采用COH+IVF-ET+中藥,對(duì)照組采用COH+IVF-ET,兩組COH+IVF-ET方法相同。中藥治療以補(bǔ)腎益氣和血為治法,分兩個(gè)治療階段:第一階段為胚胎移植前整體調(diào)理,以補(bǔ)腎益氣活血為治法,給予補(bǔ)腎益氣活血法基本方辨證加減治療;第二階段為胚胎移植后助孕保胎治療,以補(bǔ)腎益氣養(yǎng)血為治法,給予補(bǔ)腎益氣養(yǎng)血法基本方辨證加減治療。中藥每日一劑煎服,早晚各一次,每次200ml,移植后給予補(bǔ)腎益氣養(yǎng)血方加減的同時(shí),聯(lián)合使用黃體酮注射液60mg,每日肌肉注射一次,至移植后14天,之后根據(jù)患者血β-HCG、P值調(diào)整劑量。移植前與移植后中藥治療的療程均為1~3個(gè)月,根據(jù)患者具體癥狀變化,每1~2周復(fù)診調(diào)整藥物。采用陰道B超檢測(cè)hCG日兩組患者的子宮內(nèi)膜厚度、類型及hCG日和ET日雙側(cè)子宮動(dòng)脈血流參數(shù),并進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果本研究?jī)山M患者的一般情況,如平均年齡、平均不孕年限、BMI、基礎(chǔ)性激素、Gn用量等比較均無(wú)顯著統(tǒng)計(jì)學(xué)差異(P0.05)。hCG日子宮內(nèi)膜厚度中藥組(10.92±1.59)mm高于對(duì)照組(10.43±1.58)mm,但兩組比較無(wú)顯著性差異(P0.05),A型內(nèi)膜在中藥組所占比例為80.0%(24/30),在對(duì)照組為53.3%(16/30),兩組比較有顯著性差異(P0.05);中藥組患者h(yuǎn) CG日和ET日雙側(cè)子宮動(dòng)脈搏動(dòng)指數(shù)(PI)及阻力指數(shù)(RI)均明顯低于對(duì)照組,差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。結(jié)論補(bǔ)腎益氣和血法中藥聯(lián)合IVF-ET治療時(shí),移植前給予中藥補(bǔ)腎益氣活血方加減,移植后給予補(bǔ)腎益氣養(yǎng)血方加減,可能有利于改善子宮內(nèi)膜厚度和形態(tài),增強(qiáng)子宮內(nèi)膜容受性,調(diào)節(jié)子宮動(dòng)脈血流狀態(tài)。
[Abstract]:Objective the purpose of this study was to evaluate the effect of traditional Chinese medicine (TCM) for tonifying kidney and tonifying qi and blood on improving endometrium and uterine blood flow in women with IVF-ET by interventional therapy with traditional Chinese medicine (TCM) in the course of IVF-ET treatment of infertile women. Methods 60 cases of oviduct infertility with IVF-ET were randomly divided into Chinese medicine group (30 cases) and control group (30 cases). The Chinese medicine group was treated with COH IVF-ET Chinese medicine, the control group was treated with COH IVF-ET.The two groups had the same COH IVF-ET method. The traditional Chinese medicine therapy takes tonifying kidney and supplementing qi and blood as the treatment method, which is divided into two stages: the first stage is the whole conditioning before embryo transfer, the method of tonifying kidney and invigorating qi and activating blood as the treatment method, and the basic prescription of tonifying kidney benefiting qi and activating blood circulation is added and subtracted; The second stage is the treatment of pregnancy and fetal preservation after embryo transfer, and the treatment of tonifying kidney and nourishing qi and nourishing blood is the basic prescription of tonifying kidney and invigorating qi and nourishing blood. Traditional Chinese medicine was decoction once a day, one time in the morning and evening, 200ml each time. After transplantation, the decoction for tonifying kidney and tonifying qi and nourishing blood was added or subtracted, and at the same time, the injection of progesterone was combined with 60 mg of progesterone injection once a day until 14 days after transplantation, and then the dosage was adjusted according to the value of 尾 -HCG P in the patient's blood. The course of treatment was 1 ~ 3 months before and after transplantation. The endometrial thickness, type and blood flow parameters of bilateral uterine arteries on hCG day and et day were measured by vagina B ultrasound in two groups on the day of hCG, and statistical analysis was carried out. Results the general conditions of the two groups, such as average age, There was no significant difference in BMIand Gn dosage of basic sex hormone between the two groups (P0.05). The thickness of endometrium in the TCM group was (10.92 鹵1.59) mm higher than that in the control group (10.43 鹵1.58) mm, but there was no significant difference between the two groups (P0.05) the proportion of type A endometrium in the TCM group was 80.0% (24 / 30). In the control group, 53.3% (16 / 30), there was a significant difference between the two groups (P0.05), the bilateral uterine artery pulsatility index (PI) and resistance index (RI) in the traditional Chinese medicine group were significantly lower than those in the control group on hCG day and et day. The difference was statistically significant (P0.01). Conclusion in the treatment of tonifying kidney and tonifying qi and blood therapy combined with IVF-ET, adding or decreasing of Bushen Yiqi Huoxue prescription before transplantation and Bushen Yiqi nourishing blood prescription after transplantation may help to improve the thickness and morphology of endometrium and enhance endometrial receptivity. Regulate uterine artery blood flow.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R714.8

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