【摘要】：目的:通過回顧性病例分析探討胎盤植入的發(fā)病因素,并總結(jié)莪棱元坤合劑聯(lián)合西藥治療胎盤植入的臨床療效及安全性,以期為胎盤植入的規(guī)范性診療尋找一個有效、安全、低毒的最佳治療方案,為莪棱元坤合劑的推廣應(yīng)用提供臨床依據(jù)。方法:選取山東省立醫(yī)院婦產(chǎn)科病房2014年1月-2016年12月收治的98例胎盤植入患者,按照1:2的比例隨機(jī)抽取同期196例非胎盤植入產(chǎn)婦作為對照,對兩組年齡、文化程度、孕產(chǎn)次等一般資料進(jìn)行研究分析,以探討本病的發(fā)病因素;并根據(jù)治療用藥情況將收集到的胎盤植入患者進(jìn)行分組:其中應(yīng)用“莪棱元坤合劑+甲氨蝶呤+米非司酮方案”治療的30例(A組),用“甲氨蝶呤+米非司酮方案”治療的26例(B組),分析比較兩組的臨床總體療效、人絨毛膜促性腺激素(血β-HCG值)治療前后變化情況、胎盤植入面積大小變化、陰道流血情況及藥物毒副作用。結(jié)果:通過胎盤植入組與同期非胎盤植入組一般臨床特征比較分析可見,高齡、孕產(chǎn)次、流產(chǎn)史、前置胎盤和妊娠合并高血壓疾病是胎盤植入的危險(xiǎn)致病因素,其中前置胎盤和妊娠合并高血壓疾病則是胎盤植入的獨(dú)立危險(xiǎn)因素。在臨床療效方面,A組治療有效率為100%,B組治療有效率為84.61%,兩組比較有差異性(P0.05)。在降低血β-HCG值方面,兩組治療后血β-HCG值均較治療前有明顯下降(P0.01);治療后的血β-HCG值A(chǔ)組下降更為明顯,與B組比較有顯著差異性(P0.01)。在胎盤植入面積方面,兩組治療后較治療前明顯縮小(P0.01);A組胎盤植入面積縮小情況較B組更為顯著,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。在子宮縮復(fù)情況方面,兩組治療后較治療前有顯著差異性(P0.01);A組促進(jìn)產(chǎn)后子宮修復(fù)的作用明顯高于B組,兩組比較有顯著差異性(P0.01)。在治療陰道流血方面,A組的陰道流血停止時間明顯短于B組,兩組比較有顯著差異性(P0.01)。從不良反應(yīng)及藥物的毒副反應(yīng)方面來講,A組出現(xiàn)食欲減退、惡心嘔吐、腹脹腹瀉、過敏反應(yīng)及藥物毒副反應(yīng)的例數(shù)明顯少于B組,兩組比較有差異性(P0.05)。結(jié)論:莪棱元坤合劑、甲氨蝶呤、米非司酮三藥聯(lián)用是保守治療胎盤植入的有效方法,莪棱元坤合劑既提高了臨床治療的有效率,同時減輕了藥物的毒副作用,而且能促進(jìn)子宮修復(fù)和胎盤植入組織壞死、脫落,最大程度上保留了女性的生殖功能,不失為臨床上用之有效的中藥制劑,值得推廣應(yīng)用。
[Abstract]:Objective: to explore the etiological factors of placenta accreta by retrospective case analysis, and to summarize the clinical efficacy and safety of Eulingyuan Kun mixture combined with western medicine in the treatment of placenta accreta, in order to find an effective and safe way for the normative diagnosis and treatment of placenta accreta. The best treatment scheme of low toxicity provides clinical basis for the popularization and application of E-Leng Yuankun mixture. Methods: 98 patients with placenta accreta were selected from the Department of Obstetrics and Gynecology of Shandong Provincial Hospital from January 2014 to December 2016. 196 women with non-placenta implantation were randomly selected as control group according to the proportion of 1:2. The age and education level of the two groups were compared. The general data of pregnancy and parturition were studied and analyzed in order to explore the pathogenesis of the disease. The patients were divided into three groups according to the medication: 30 cases were treated with methotrexate mifepristone regimen (group A), and 30 cases were treated with "methotrexate mifepristone regimen" (group A), and the patients were treated with "methotrexate mifepristone regimen" (group A). "A total of 26 cases (group B) were treated, and the overall clinical efficacy of the two groups was analyzed and compared. The changes of human chorionic gonadotropin (尾 -HCG), placenta accreta area, vaginal bleeding and side effects were observed before and after treatment. Results: comparing the general clinical features of placenta accreta group and non-placental accreta group, we can see that the risk factors of placenta accreta are old age, pregnancy, abortion history, placenta previa and pregnancy complicated with hypertension. Placenta previa and pregnancy with hypertension are independent risk factors of placenta accreta. In terms of clinical efficacy, the effective rate of treatment in group A was 100%. The effective rate of treatment in group B was 84.61, and there was a difference between the two groups (P0.05). In terms of reducing serum 尾 -HCG value, the serum 尾 -HCG value in both groups was significantly lower than that before treatment (P0.01), and the serum 尾 -HCG value in group A was significantly lower than that in group B (P0.01). In the area of placenta accreta, the two groups significantly reduced the area of placenta accreta after treatment (P0.01) than that of group B (P0.01), the difference was statistically significant (P0.05). In terms of uterine contractions, there was significant difference between the two groups after treatment (P0.01). The effect of group A on postpartum uterine repair was significantly higher than that of group B (P0.01), and there was a significant difference between the two groups (P0.01). In the treatment of vaginal bleeding, vaginal bleeding in group A was significantly shorter than that in group B, and there was significant difference between the two groups (P0.01). From the side effects and side effects of drugs, the number of cases of appetite loss, nausea and vomiting, abdominal distension and diarrhea, allergic reactions and drug side effects in group A was significantly lower than that in group B, and there was significant difference between the two groups (P0.05). Conclusion: the combination of eolingyuankun mixture, methotrexate and mifepristone is an effective method for the conservative treatment of placenta accreta. Eulingyuankun mixture not only improves the effective rate of clinical treatment, but also alleviates the toxic and side effects of the drug. Moreover, it can promote uterine repair and placental accreta necrosis and exfoliation, and retain the female reproductive function to the maximum extent. It is an effective traditional Chinese medicine preparation for clinical use, which is worth popularizing and applying.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.2

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