【摘要】：目的本研究的目的是了解補腎益氣和血法聯(lián)合黃體酮和人絨毛膜促性腺激素防治不明原因復發(fā)性流產(chǎn)（URSA）的臨床療效，證明是否能改善URSA患者的妊娠結(jié)局，提高妊娠成功率，并探討URSA的病因病機和治則治法，為中西醫(yī)結(jié)合防治URSA的優(yōu)勢提供臨床科學依據(jù)。方法本研究將符合研究標準的43例URSA患者納入研究對象，孕前以補腎益氣活血方為基本方，在辯證基礎上給予中藥治療，以一個月為一個治療周期，一般治療三個周期，或待臨床癥狀、全身狀況改善后開始試孕。孕后給予補腎益氣養(yǎng)血方加減聯(lián)合黃體酮和人絨毛膜促性腺激素治療。中藥每日一劑煎服，早晚各一次，每次200ml，西藥根據(jù)查血β-HCG、孕酮（P）值調(diào)整劑量，黃體酮注射液20~100mg，，每日肌肉注射一次，使血P值維持在30~60ng/ml；注射用人絨毛膜促性腺激素2000~3000單位，每兩日肌肉注射一次，使血β-HCG值持續(xù)穩(wěn)定增長（停經(jīng)8周之前），治療至孕后12周或超過既往流產(chǎn)孕周。觀察妊娠期間有無陰道流血情況、腹痛、腰酸等情況，監(jiān)測血β-HCG、P值，觀察妊娠結(jié)局，并根據(jù)年齡不同將URSA患者分為22~≤26歲、26~≤30歲、30~35歲三個年齡段，分析治療對不同年齡段患者是否存在療效差異。 結(jié)果本研究43例URSA患者再次妊娠率為72.09%，其中有5例患者發(fā)生再次流產(chǎn)，妊娠成功率為83.87%，其中小于30歲患者的妊娠率及妊娠成功率均高于大于30歲者（P＜0.05）。經(jīng)過治療，妊娠后血β-HCG值持續(xù)穩(wěn)定增長（停經(jīng)8周之前），血P值維持在30~60ng/ml，再次妊娠者先兆流產(chǎn)相關(guān)癥狀、小腹下墜或隱痛不適、納差、大便稀溏、神疲肢倦或面色晦暗無華等得到改善，但腰酸不適癥狀無明顯改善，臨床癥狀療效總有效率為83.87%，但與年齡無關(guān)。 結(jié)論URSA患者孕前給予中藥補腎益氣活血方加減，孕后給予補腎益氣養(yǎng)血方加減聯(lián)合黃體酮和人絨毛膜促性腺激素，可改善臨床癥狀，維持血β-HCG、P值在較好水平，改善再次妊娠結(jié)局，提高再次妊娠率和妊娠成功率。
[Abstract]:Objective to investigate the clinical effect of tonifying kidney and supplementing qi and blood therapy combined with progesterone and human chorionic gonadotropin (HCG) in the prevention and treatment of unexplained recurrent abortion (URSA), and to prove whether it can improve pregnancy outcome and increase pregnancy success rate in patients with URSA. To explore the etiology, pathogenesis and treatment of URSA, to provide clinical scientific basis for the advantages of integrated Chinese and western medicine in the prevention and treatment of URSA. Methods in this study, 43 URSA patients who met the study criteria were included in the study. Before pregnancy, Bushen Yiqi Huoxue prescription was taken as the basic prescription, and the traditional Chinese medicine was given on the basis of dialectical treatment, one month as the treatment cycle, and three cycles of general treatment. Or wait for clinical symptom, whole body condition improves after begin to test pregnancy. After pregnancy, Bushen Yiqi Yangxue prescription plus or minus progesterone and human chorionic gonadotropin treatment. Traditional Chinese medicine decoction once a day, morning and evening, each time 200ml, the western medicine according to check blood 尾-HCG, progesterone (P) value adjustment dose, progesterone injection 20g 100mg, intramuscular injection once a day, so that the blood P value maintained at 30 ~ 60ng / ml; Human chorionic gonadotropin (HCG) 2000000 units was injected intramuscularly every two days. The serum 尾-HCG value increased steadily (before 8 weeks of menopause) and reached 12 weeks after pregnancy or exceeded the gestational week of previous abortion. To observe whether there were vaginal bleeding, abdominal pain, lumbar acid and so on during pregnancy, to monitor serum 尾-HCG,P value, to observe pregnancy outcome, and to divide URSA patients into three age groups according to their age: 22 ~ 鈮

本文編號：2413090