【摘要】：目的:本課題研究的目的為運用自擬方補腎活血湯聯(lián)合達肝素鈉針治療子宮動脈血流異常的復發(fā)性流產。通過對臨床療效的觀察,總結中藥聯(lián)合達肝素鈉在治療子宮動脈血流異常的復發(fā)性流產中的優(yōu)勢,為提高藥物治療復發(fā)性流產的臨床療效提供依據。方法:本研究將子宮動脈血流異常的復發(fā)性流產(腎虛血瘀型)患者60例,隨機分成治療組與對照組,每組各30人。治療組予自擬方補腎活血湯口服聯(lián)合達肝素鈉針皮下注射,對照組單純予以達肝素鈉針皮下注射。14天為一療程,治療至妊娠滿12周或超過既往流產時間。通過檢測治療組與對照組治療前后的人絨毛膜促性腺激素、孕酮及超聲下胚胎發(fā)育情況、子宮動脈血流阻力變化情況,觀察兩組患者治療后的臨床療效及妊娠結局。結果:1.在臨床總療效的比較上,治療組治愈16例,占53.33%,顯效4例,占13.33%,有效6例,占20.00%,無效4例,占13.33%,總有效率86.67%;對照組治愈6例,占20.00%,顯效3例,占10.00%,有效7例,占23.33%,無效14例,占46.67%,總有效率53.33%,治療組優(yōu)于對照組(P0.05)。2.在證候積分的比較上,治療組治療前后和對照組治療前后的證候積分在差異上均具有顯著的統(tǒng)計學意義(P0.01),治療組與對照組治療后證候積分具有顯著的統(tǒng)計學差異(P0.01)。3.在子宮動脈血流阻力指數上,治療組治療前后和對照組治療前后的子宮動脈血流雙側RI、S/D差異均有顯著的統(tǒng)計學意義(P0.01),治療組與對照組治療后的雙側RI、S/D差異均具有統(tǒng)計學意義(P0.05)。4.在血清β-HCG和孕酮(P)比較中,治療組和對照組治療前后即妊娠6周末與10周末的血清β-HCG和P差異均有顯著的統(tǒng)計學意義(P0.01),治療組與對照組治療后即妊娠10周末的血清β-HCG和P差異具有統(tǒng)計學意義(P0.05)。5.在兩組患者治療后妊娠結局的比較中,治療組26例治愈,4例無效,其總有效率為86.67%,對照組17例治愈,13例無效,總有效率為56.67%,治療組與對照組的妊娠結局具有統(tǒng)計學差異(P0.05)。對兩組患者隨訪中,胎兒及嬰兒均未見發(fā)育畸形。結論:補腎活血方聯(lián)合達肝素鈉針能明顯提高子宮動脈血流異常的復發(fā)性流產的妊娠成功率,并能降低子宮動脈血流阻力,調節(jié)血液循環(huán),其臨床療效可靠,值得推廣。
[Abstract]:Objective: to treat recurrent abortion with Bushen Huoxue decoction and Diheparin Sodium Needle in the treatment of uterine artery blood flow abnormality. Through the observation of clinical curative effect, the advantages of combination of traditional Chinese medicine and diheparin sodium in the treatment of recurrent abortion with abnormal uterine artery blood flow were summarized in order to provide the basis for improving the clinical efficacy of medicine in the treatment of recurrent abortion. Methods: 60 patients with recurrent abortion (kidney deficiency and blood stasis) with abnormal uterine artery blood flow were randomly divided into treatment group and control group with 30 patients in each group. The treatment group was treated with self-formulated Bushen Huoxue decoction and subcutaneous injection of sodium dheparin, while the control group was only given subcutaneous injection of sodium dharparin. 14 days was a course of treatment, until the pregnancy reached 12 weeks or more than the time of previous abortion. The development of human chorionic gonadotropin progesterone and ultrasound and the changes of uterine artery blood flow resistance were measured before and after treatment in the treatment group and control group. The clinical efficacy and pregnancy outcome of the two groups were observed. The result is 1: 1. 16 cases were cured in the treatment group (53.33%), 4 cases were markedly effective (13.33), 6 cases (20.00%) were effective, 4 cases were ineffective (13.33%), and the total effective rate was 86.67 (P < 0.05). In the control group, 6 cases were cured (20.00%), 3 cases were markedly effective (10.00%), 7 cases were effective (23.33 cases), 14 cases (46.67%) were ineffective, and the total effective rate was 53.33%. The treatment group was better than the control group (P0.05). In the comparison of syndrome score, the difference of syndrome score before and after treatment in treatment group and control group was statistically significant (P0.01). Treatment group and control group after treatment had significant difference in syndrome score (P0.01). In the uterine artery blood flow resistance index, there were significant differences in bilateral RI,S/D between the treatment group and the control group before and after treatment (P0.01). The bilateral RI, in the treatment group and the control group after treatment were significantly different (P0.01). The difference of S / D was statistically significant (P0.05). In the comparison of serum 尾-HCG and progesterone (P), there were significant differences in serum 尾-HCG and P between the treatment group and the control group before and after treatment, that is, at the 6th and 10th week of pregnancy (P0.01). The serum 尾-HCG and P in the treatment group and the control group were significantly different from those in the control group after 10 weeks of pregnancy (P0.05). In the two groups, 26 cases were cured, 4 cases were ineffective, and the total effective rate was 86.67%. In the control group, 17 cases were cured, 13 cases were ineffective, and the total effective rate was 56.67%. The pregnancy outcomes of the treatment group and the control group were statistically different (P0.05). There were no developmental deformities in the fetus and infants during the follow-up of the two groups. Conclusion: Bushen Huoxue prescription combined with heparin sodium needle can significantly improve the pregnancy success rate of recurrent abortion with abnormal uterine artery blood flow, reduce uterine artery blood flow resistance, regulate blood circulation, and its clinical efficacy is reliable and worth popularizing.
【學位授予單位】：安徽中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R714.21

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