【摘要】：目的:分析人工流產(chǎn)患者術(shù)前陰道微生態(tài)結(jié)果,探討陰道微生態(tài)評(píng)估在人工流產(chǎn)術(shù)前的臨床應(yīng)用價(jià)值,了解陰道微生態(tài)的臨床應(yīng)用現(xiàn)狀。方法:1.收集2016年10月-2017年1月于重慶醫(yī)科大學(xué)附屬第二醫(yī)院門(mén)診行人工流產(chǎn)的504例患者陰道分泌物,進(jìn)行陰道微生態(tài)評(píng)估及臨床癥狀分析。2.通過(guò)對(duì)部分婦產(chǎn)科醫(yī)生進(jìn)行調(diào)查問(wèn)卷,了解陰道微生態(tài)應(yīng)用現(xiàn)狀及醫(yī)務(wù)人員對(duì)陰道微生態(tài)的知曉度。結(jié)果:1.504例陰道微生態(tài)評(píng)估結(jié)果顯示:微生態(tài)正常214例(42.5%),微生態(tài)異常290例(57.5%);在290例陰道微生態(tài)異常中:陰道炎癥120例(120/290),陰道微生態(tài)失衡170例(170/290)。在120例陰道炎癥中:清潔度異常32例(6.3%)、外陰陰道假絲酵母菌病(vulvovaginal candidiasis,VVC)51例(10.1%),細(xì)菌性陰道病(bacterial vaginosis,BV)29例(5.8%),混合感染8例(1.6%),其中BV和VVC混合感染7例(1.4%),BV和滴蟲(chóng)性陰道炎(trichomonal vaginitis,TV)混合感染1例(0.2%);在170例陰道微生態(tài)失衡中:PH值異常38例(7.5%)、乳桿菌數(shù)目異常162例(32.4%)、乳桿菌功能異常60例(11.9%)、優(yōu)勢(shì)菌異常161例(31.9%)、菌群抑制9例(1.8%)。2.290例陰道微生態(tài)異常菌群功能學(xué)結(jié)果:1)過(guò)氧化氫陽(yáng)性共115例:BV4例(13.8%4/29),VVC45例(88.2%45/51),混合感染8例(100%),清潔度異常15例(46.9%15/32),ph異常33例(86.8%33/38),乳桿菌數(shù)目異常56例(34.6%56/162),乳桿菌功能異常60例(100%),優(yōu)勢(shì)菌異常59例(36.6%59/161),菌群抑制1例(11.1%1/9);2)白細(xì)胞酯酶陽(yáng)性共120例:bv29例(100%),vvc51例(100%),混合感染8例(100%),清潔度異常20例(62.5%20/32),ph異常7例(18.4%7/38),乳桿菌數(shù)目異常13例(8%13/162),乳桿菌功能異常9例(15%9/60),優(yōu)勢(shì)菌異常14例(8.7%14/161),菌群抑制0例;3)唾液酸苷酶陽(yáng)性共32例:bv29例(100%),vvc0例,混合感染6例(75%6/8),清潔度異常2例(6.2%2/8),ph異常1例(2.6%1/38),乳桿菌數(shù)目異常1例(0.6%1/162),乳桿菌功能異常1例(1.7%1/60),優(yōu)勢(shì)菌異常1例(0.6%1/161),菌群抑制0例。3.290例陰道微生態(tài)異常患者中,無(wú)臨床癥狀患者186例(64.1%186/290),包括70例陰道炎癥、116例陰道微生態(tài)失衡;有臨床癥狀患者104例(35.9%104/290)包括50例陰道炎癥、54例陰道微生態(tài)失衡,臨床癥狀包括白帶異常(白帶增多、異味及顏色異常)98例,外陰瘙癢82例,外陰灼痛26例。4.對(duì)154名婦產(chǎn)科醫(yī)生進(jìn)行陰道微生態(tài)現(xiàn)狀調(diào)查問(wèn)卷結(jié)果顯示:119名醫(yī)生對(duì)陰道微生態(tài)知曉(77.3%),余下35名(22.7%)醫(yī)生對(duì)陰道微生態(tài)表示不了解。119名對(duì)陰道微生態(tài)知曉的醫(yī)生中有116人(97.5%116/119)認(rèn)為陰道微生態(tài)對(duì)于陰道感染性疾病的診治具有臨床指導(dǎo)意義。5.在問(wèn)卷調(diào)查中大多數(shù)婦產(chǎn)科醫(yī)生認(rèn)為:陰道炎癥重、反復(fù)陰道感染的患者應(yīng)該進(jìn)行陰道微生態(tài)評(píng)估;陰道炎用藥后隨訪患者應(yīng)行陰道微生態(tài)評(píng)估;陰道微生態(tài)評(píng)估提示微生態(tài)失調(diào)時(shí)應(yīng)短期動(dòng)態(tài)觀察微生態(tài)變化情況。結(jié)論:陰道微生態(tài)評(píng)估能夠發(fā)現(xiàn)人工流產(chǎn)患者術(shù)前陰道炎癥及微生態(tài)失衡狀態(tài),人工流產(chǎn)患者因機(jī)體內(nèi)分泌改變?nèi)菀装l(fā)生陰道微生態(tài)失衡,臨床醫(yī)生應(yīng)重視人工流產(chǎn)患者術(shù)前陰道微生態(tài)評(píng)估。目前大部分臨床婦產(chǎn)科醫(yī)生(116/154)能夠明確陰道微生態(tài)概念及臨床意義且能合理地運(yùn)用陰道微生態(tài)評(píng)估。
[Abstract]:Objective: To analyze the microecological results of the pre-operative vaginal microecology in the patients with induced abortion, and to study the clinical application value of the vaginal microecological assessment before and after induced abortion and to understand the clinical application of the microecology of the vagina. Method:1. The vaginal discharge of 504 patients with artificial abortion in the second hospital of Chongqing Medical University was collected from October 2016 to January 2017, and the vaginal microecological assessment and the clinical symptom analysis were performed. The present situation of the microecological application of the vagina and the awareness of the medical staff on the microecology of the vagina were studied by the questionnaire of some obstetricians and obstetrics doctors. Results: 1.504 cases of vaginal microecological assessment showed that the microecological normal 214 cases (42.5%) and the micro-ecological abnormality in 290 cases (57.5%); in 290 vaginal microecological abnormalities:120 cases (120/290) of vaginal inflammation and 170 cases (170/290) of microecological imbalance in the vagina. In 120 cases of vaginal inflammation, the cleanliness was abnormal in 32 (6.3%), vulvovaginal candidiasis (VVC) in 51 (10.1%), bacterial vaginosis (BV) in 29 (5.8%), and mixed infection in 8 (1.6%), of which BV and VVC were mixed in 7 cases (1.4%). BV and trichomonas vaginitis (TV) mixed infection in 1 case (0.2%); in 170 cases of vaginal microecological imbalance: the PH value was abnormal 38 (7.5%), the number of lactobacilli was 162 (32.4%), the function of Lactobacillus was abnormal in 60 (11.9%), and the dominant bacteria were abnormal in 161 (31.9%). The microflora of the vagina was inhibited in 9 cases (1.8%). 2.290 cases of vaginal microecological abnormal microflora (1) hydrogen peroxide positive in 115 patients: BV4 (13.8%4/29), VVC45 (88.2%45/51), mixed infection in 8 (100%), cleanliness abnormality in 15 (46.9%15/32), ph abnormal 33 (86.8%33/38), There were 56 cases (34.6%56/162),60 (100%),59 (36.6%59/161),1 (11.1%1/9), and 1 (100%), and 8 (100%) mixed infection, in which the number of lactobacilli was abnormal (34.6%56/162), the function of Lactobacillus was 60 (100%), the dominant bacteria were abnormal in 59 (36.6%59/161), and the flora was inhibited in one case (11.1%1/9);2) the white blood cell esterase was positive in 120 cases: bv29 (100%), vvc51 (100%), and mixed infection in 8 cases (100%). The cleanliness was abnormal in 20 cases (62.5%20/32), the ph was abnormal in 7 (18.4%7/38), the number of lactobacilli was 13 (8%13/162), the function of the lactobacillus was abnormal in 9 (15%9/60), the dominant bacteria were abnormal in 14 (8.7%14/161), the flora inhibited 0,3) the positive total of the sialyl was 32: bv29 (100%), vvc0, 6 cases (75%6/8) of mixed infection,2 cases (6.2%2/8),1 case (2.6%1/38),1 case (0.6%1/162),1 case (1.7%1/60) of lactobacillus,1 case (0.6%1/161) of dominant bacteria and 0 cases of microflora. 186 patients with no clinical symptoms (64.1%186/290), including 70 vaginal inflammation and 116 vaginal microecological imbalance;104 (35.9%104/290) of the patients with clinical symptoms included 50 vaginal inflammation,54 vaginal microecological imbalances, clinical symptoms including white-band abnormalities (white-band increase, off-flavor, and color abnormalities) of 98, The vulvar itching was 82 cases, and the vulvar burning pain was 26 cases. The results of the survey of the vaginal microecological status of 154 obstetricians and gynaecologists showed that 119 doctors were aware of the microecology of the vagina (77.3%). The remaining 35 (22.7%) doctors did not know about the microecology of the vagina. Of the 119,116 (97.5%116/119) of the 119 microecological know-how, the vaginal microecology has a clinical guiding significance for the diagnosis and treatment of the vaginal infectious diseases. In the questionnaire, most of the obstetricians of the department of obstetrics and gynecology considered that the vaginal microecological assessment should be carried out in the patients with severe vaginal inflammation and recurrent vaginal infections, and the follow-up patients should be followed up for vaginal microecological assessment after the treatment of vaginitis; The microecological change of the microecological imbalance should be observed in short-term in the microecological assessment of the vagina. Conclusion: The vaginal microecological assessment can find the pre-operative vaginal inflammation and microecological imbalance in the patients with induced abortion. At present, most of the clinical obstetrics and gynecology doctors (116/154) can define the concept and clinical significance of the vaginal microecology and can reasonably use the vaginal microecological assessment.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R169.42

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