【摘要】：目的:本研究觀察我院過去五年內(nèi)的輸卵管妊娠藥物治療患者,在"輸卵管妊娠診療方案"指導(dǎo)治療下,輸卵管妊娠藥物保守治療成功的附件殘留包塊及盆腔積液等方面的臨床療效;通過對比分析各組治療前后的包塊大小以及已破損期治療前后盆腔積液情況,以探討中醫(yī)藥治療的作用機(jī)理,為治療本病提供客觀詳實(shí)的依據(jù),也為輸卵管妊娠診療方案的進(jìn)一步優(yōu)化提供建議。方法:采用回顧性分析方法,回顧廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院婦科病房中,于2012年1月1日至2016年12月31日住院的共1730例輸卵管妊娠患者,嚴(yán)格按照納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn)篩選出符合要求的病例245例。所有納入病例均符合"輸卵管妊娠中西醫(yī)結(jié)合治療方案"中中醫(yī)或中西醫(yī)結(jié)合藥物治療規(guī)范,同時(shí)滿足出院時(shí)血β-hCG轉(zhuǎn)陰或下降≥90%。按照病例信息采集表,記錄患者入院時(shí)的臨床癥狀、妊娠三項(xiàng)結(jié)果、妊娠包塊大小、盆腔積液以及出院時(shí)復(fù)查的妊娠指標(biāo)數(shù)值,并根據(jù)上述信息制作Excel表格并建立數(shù)據(jù)庫,將收集的患者資料進(jìn)行歸納。按照患者的辨病分期和辨證分型(詳見表1)以及輸卵管妊娠病情影響因子積分(詳見表2)進(jìn)行分組,共分成5組,依次用A-E表示。其中A、B組采用中藥治療,C、D、E組予中西醫(yī)結(jié)合藥物治療,分別比較各組治療前后的包塊變化情況。所有數(shù)據(jù)采用SPSS 22.0統(tǒng)計(jì)軟件包進(jìn)行統(tǒng)計(jì)學(xué)處理,結(jié)果均以x±s表示,各組前后包塊變化采用Wilcoxo符號秩和檢驗(yàn),P0.05視為有統(tǒng)計(jì)學(xué)差異。結(jié)果:1.A組:未破損期胎元阻絡(luò)型,積分≤8分,血β-hCG1000IU/L時(shí),治療前后妊娠包塊體積變化有統(tǒng)計(jì)學(xué)差異,同時(shí)觀察治療前后妊娠包塊大小的平均值,有明顯下降趨勢。2.B組:已破損期正虛血瘀型,積分≤9分,血β-hCG1000IU/L,治療前后平均妊娠包塊體積、盆腔積液體積有明顯下降。但因觀察時(shí)間、個(gè)體差異等,可能導(dǎo)致了統(tǒng)計(jì)學(xué)上未顯示差異性。3.C組:未破損期胎元阻絡(luò)型,積分≤8分,血β-hCG≥1000IU/L或包塊最大徑5cm時(shí),治療后輸卵管妊娠平均包塊體積均較前有所增長。對比A組結(jié)果,考慮包塊的消散可能與妊娠滋養(yǎng)細(xì)胞活性相關(guān)。4.D組:未破損期胎元阻絡(luò)型中積分=9-10分,治療后的平均妊娠包塊體積均有明顯減小趨勢。5.E組:已破損期正虛血瘀型中積分≤9分,血β-hCG≥1000IU/L時(shí),治療后平均包塊體積有所下降,但下降趨勢緩慢,盆腔積液下降趨勢明顯。6.考慮妊娠包塊內(nèi)部張力與滋養(yǎng)細(xì)胞活性間關(guān)系,按照妊娠包塊縱/橫徑比值分為比值2和比值≥2兩組,已破損期孕酮值比較,差異有統(tǒng)計(jì)學(xué)意義,余均無統(tǒng)計(jì)學(xué)差異。說明包塊縱/橫徑比大小與滋養(yǎng)細(xì)胞活性無明顯關(guān)聯(lián)。但根據(jù)兩組指標(biāo)均值比較,妊娠包塊縱/橫比2和比值≥2組中,縱/橫比較大時(shí),血β-hCG值和P值相對較低。推測輸卵管妊娠包塊縱/橫比越大,可能更易出現(xiàn)輸卵管妊娠破裂或流產(chǎn)情況發(fā)生。而結(jié)合孕酮作用機(jī)制：P水平低下時(shí),無法維持妊娠,又無法拮抗雌激素對輸卵管平滑肌的節(jié)律性收縮,可能導(dǎo)致輸卵管妊娠流產(chǎn)。這恰好與本研究結(jié)果一致。7.經(jīng)治療,A至E各組對包塊改善的有效率分別為71.9%、63.64%、51.61%、63.64%、76.47%。整體總有效率68.16%�？梢钥闯�,C組即對應(yīng)的未破損期胎元阻絡(luò)型,當(dāng)積分≤8分,hCG≥1000IU/L或輸卵管妊娠包塊最大徑≥5cm時(shí),妊娠包塊縮小方面效果不顯,推測針對該型患者,治療過程中需增加針對減小包塊的治療,如相對加大活血化瘀消ve力度,從而加快輸卵管妊娠包塊的消散。結(jié)論:1.輸卵管妊娠中西醫(yī)結(jié)合診療方案在發(fā)揮中醫(yī)藥殺胚治療的同時(shí),對輸卵管妊娠包塊的治療有效。對于抑制輸卵管妊娠包塊的增大,加速包塊吸收,改善盆腔血液循環(huán)狀況,緩解癥狀方面具有顯著的優(yōu)勢。2.針對未破損期胎元阻絡(luò)型,積分≤8分,血β-hCG≥1000IU/L或包塊最大徑≥5cm的患者,建議今后治療過程中增加針對性治療,如相對加大活血化瘀消ve力度,加快輸卵管妊娠包塊的消散。3.包塊縱/橫徑比值與滋養(yǎng)細(xì)胞活性無明顯關(guān)聯(lián),但當(dāng)輸卵管妊娠包塊縱/橫比較大時(shí),可能更易出現(xiàn)輸卵管妊娠破裂或流產(chǎn)情況發(fā)生。
[Abstract]:Objective: To observe the clinical effect of tubal pregnancy drug conservative treatment in patients with tubal pregnancy and pelvic effusion in the past five years in our hospital under the guidance of "The diagnosis and treatment plan of tubal pregnancy". By contrasting and analyzing the size of the bag before and after the treatment and the cases of pelvic effusion before and after treatment, the mechanism of the treatment of traditional Chinese medicine was discussed, and the objective and detailed basis for the treatment of the disease were provided, and the suggestion was also made for the further optimization of the diagnosis and treatment scheme of the tubal pregnancy. Methods: Retrospective analysis was used to retrospectively analyze the cases of tubal pregnancy in the first affiliated hospital of Guangzhou University of Traditional Chinese Medicine, which was admitted on Jan. 1, 2012 to December 31, 2016, and 245 cases were screened according to the criteria and exclusion criteria. All included cases are in accordance with Chinese medicine or traditional Chinese and western medicine combination drug treatment specification in "Treatment of tubal pregnancy combined with traditional Chinese and western medicine", and at the same time, the amount of blood-hCG-hCG at discharge can be met or reduced by 90%. According to the case information collection table, record the clinical symptoms, three pregnancy outcomes, the size of the pregnancy package block, the pelvic effusion and the pregnancy index values reviewed during discharge, and prepare the Excel table according to the above information and establish a database to summarize the collected patient data. The group was divided into 5 groups according to the patient's disease stage and syndrome differentiation type (see Table 1) and the effect factor integration of tubal pregnancy (see Table 2 for details), which was expressed in sequence A-E. Group A and group B were treated with traditional Chinese medicine, C, D and E were treated with traditional Chinese and western medicine, and the changes of bag block before and after treatment were compared. All the data were subjected to statistical processing using SPSS 10.0 statistical software. The results were expressed as x/ s, and the changes of the pre-and post-post-package blocks in each group were treated with Wilcoxon signed rank and test, P0.05. Results: 1. A group: there was a statistical difference in the volume change of pregnancy bag before and after treatment, while the mean value of the block size of pregnancy bag before and after treatment was observed. The volume of the average gestational age group and the volume of pelvic effusion were significantly decreased before and after treatment. However, due to the observation time, individual difference and so on, there may be no statistically significant difference. Compared with the results of group A, the dissipation of the block was considered to be related to the activity of gestational trophoblastic cells. The volume of average bag block decreased, but the trend of decline was slow and the trend of pelvic effusion decreased. In consideration of the relationship between the internal tension of pregnancy bag block and the activity of trophoblast cells, the ratio of longitudinal/ transverse diameter ratio was divided into two groups: ratio 2 and ratio: 2 groups. The ratio of longitudinal/ transverse diameter of package block was not significantly associated with the activity of trophoblast cells. However, compared with the mean value of the two groups, the values of P-hCG and P were relatively low when the longitudinal/ transverse ratio of the pregnancy package was larger than that of the two groups. It is estimated that the greater the longitudinal/ lateral ratio of the tubal pregnancy package, the more likely the occurrence of tubal pregnancy rupture or miscarriage can occur. In combination with progesterone action mechanism: P level is low, pregnancy can not be maintained, and the rhythmic contraction of estrogen on tubal smooth muscle can not be antagonized, which may lead to abortion of tubal pregnancy. This is exactly consistent with the results of this study. 7. The effective rates of group A to E were 71.9%, 63. 64%, 51. 61%, 63. 64%, 76. 47%, respectively. Overall total effective rate was 68. 16%. It can be seen that the C group is the corresponding non-damaged fetus meta-resistance complex, when the score is 8 points, the hCG concentration is 1000IU/ L or the maximum diameter of the tubal pregnancy bag block is 0.5cm, the effect on the reduction of the gestational bag block is not obvious, therefore, the treatment for reducing the bag block needs to be increased in the treatment process aiming at the patients with the type. such as increasing blood circulation and removing blood stasis and removing blood stasis so as to speed up the dissipation of the tubal pregnancy bag block. Conclusion: 1. The treatment scheme of tubal pregnancy and western medicine combined with the diagnosis and treatment of tubal pregnancy is effective for the treatment of tubal pregnancy bag block. It has a significant advantage in inhibiting the enlargement of the tubal pregnancy bag block, accelerating the absorption of the bag block, improving the pelvic blood circulation condition and relieving the symptoms. Aiming at the patients with non-damaged pregnancy meta-resistance, the score was 8 points, the blood count-hCG ratio was 1000IU/ L or the maximum diameter of the bag block was 0.5cm, it was suggested to increase the targeted treatment in the future treatment, such as increasing blood circulation and removing blood stasis and eliminating eve, and speeding up the dissipation of the block of tubal pregnancy. The ratio of longitudinal/ transverse diameter of the package block is not significantly associated with the activity of trophoblast, but when the longitudinal/ transverse comparison of the tubal pregnancy bag block is large, the occurrence of tubal pregnancy rupture or abortion may be more likely to occur.
【學(xué)位授予單位】：廣州中醫(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

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