本文選題：臨床　切入點(diǎn)：評價(jià)　出處：《泰山醫(yī)學(xué)院》2013年碩士論文

【摘要】：目的 藥流結(jié)局的臨床評價(jià)，多數(shù)用超聲。本文探討彩色多普勒血流成像（以下簡稱CDFI）的血流信號監(jiān)測在決定是否需行清宮術(shù)時(shí)的臨床意義。 方法 2012年1月至2013年2月在我院確診為宮內(nèi)早孕且采用米非司酮配伍米索前列醇行藥物流產(chǎn)的患者，將其中復(fù)查彩超顯示子宮宮腔內(nèi)有略高回聲或不均質(zhì)回聲者148例。根據(jù)彩超的CDFI提示，將回聲區(qū)探及血流信號的86例作為有血流信號組（A組），余下的未探及異常血流信號的62例作為無血流信號組（B組）。將A組患者按其是否立即清宮分為兩個(gè)亞組，其中66例即刻清宮者為組1，未即刻清宮且要求繼續(xù)服用藥物者20例為組2，將B組患者按其是否繼續(xù)用藥分為兩個(gè)亞組，其中49例繼續(xù)用藥者為組3，拒絕用藥且即刻清宮者13例為組4，所有用藥患者均于用藥5天后復(fù)查彩超并進(jìn)一步處理。所有清宮者的標(biāo)本聯(lián)系病理科送檢。 結(jié)果 A組86例彩超示宮內(nèi)回聲區(qū)探及血流信號者中，組1為66例，均清宮并標(biāo)本送病理示查見絨毛和蛻膜組織，拒絕清宮且要求服藥者即組2共20例，其中16例用藥后復(fù)查彩超一至數(shù)次仍提示宮內(nèi)異�；芈暎詈笮星鍖m術(shù)，病理結(jié)果亦示查見絨毛組織和蛻膜組織，僅4例用藥后宮內(nèi)殘留組織自行排出，復(fù)查彩超結(jié)果正常。B組彩超示宮內(nèi)回聲區(qū)未探及血流信號的62例患者中，組3服藥者49例再次或數(shù)次復(fù)查彩超，最后46例超聲結(jié)果正常。僅3例清宮，，病理示蛻膜組織及血塊，組4即刻清宮者13例，病理結(jié)果顯示蛻膜組織和/或凝血塊11例，僅2例病理結(jié)果亦示查見絨毛組織。A組患者的清宮率（95.35%）和B組患者的清宮率（25.81%）差異有顯著性（P＜0.05）。 結(jié)論 藥物流產(chǎn)后宮腔內(nèi)不均質(zhì)回聲團(tuán)塊需手術(shù)清宮抑或藥物促其排出，彩超CDFI血流信號提示具有重要的監(jiān)測意義，對臨床醫(yī)師進(jìn)一步的治療有很大的指導(dǎo)意義。其對于不需清宮僅需進(jìn)一步用藥即可使宮內(nèi)殘留的蛻膜或血塊排出體外的患者來說，避免了手術(shù)創(chuàng)傷和繼發(fā)不孕等并發(fā)癥發(fā)生。
[Abstract]:Purpose. In the clinical evaluation of the outcome of drug flow, ultrasound is mostly used. This paper discusses the clinical significance of color Doppler flow imaging (CDFI) in determining whether or not to clear the uterus. Method. From January 2012 to February 2013, patients with early intrauterine pregnancy and misoprostol with mifepristone and misoprostol were diagnosed in our hospital. There were 148 cases with hyperechoic or nonechoic echo in uterine cavity. According to the CDFI indication of color Doppler ultrasound, 86 cases of echo region detecting blood flow signal were treated as group A with blood flow signal, and the remaining 62 cases of undetected and abnormal blood flow signal were treated as group B. Group A patients were divided into two subgroups according to whether they immediately cleared the uterus. Among them, 66 cases were treated as group 1 and 20 cases as group 2. Group B patients were divided into two subgroups according to whether they continued to take the medicine or not. Among them, 49 patients continued to use drugs as group 3, 13 patients refused medication and 13 patients immediately cleared the uterus as group 4. All the patients were examined by color Doppler ultrasound after 5 days of medication and further processed. All the specimens of the patients were submitted to pathology department for examination. Results. In group A, there were 66 cases in group 1 of 86 cases whose echo area was detected by color ultrasound, and 20 cases in group 2 who refused to clear uterus and asked for medication, all of them were clear of uterus and sent to pathology to detect villus and decidua tissue, and 20 cases were refused to clear uterus and asked to take medicine. Among them, 16 cases were examined by color Doppler ultrasound for one to several times to indicate abnormal echo in uterus. Finally, uterine clearance was performed. The pathological results also showed that villi and decidua tissues were found, and only 4 cases had left the residual tissues in the uterus by themselves. In group B, there were 49 cases who took medicine in group 3, 49 cases had repeated or repeated reexamination of ultrasound, only 3 cases were clear uterus, pathology showed decidua tissue and blood clot, the results of color Doppler ultrasound were normal in group B, and the echo area of intrauterine echo was not detected in group B, and 49 patients in group 3 took medicine again or several times, and the results of ultrasound were normal in the last 46 cases. There were 13 cases of immediate uterine clearance in group 4, 11 cases of decidua tissue and / or clot, and only 2 cases of chorionic villus tissue. Only 2 cases showed that there was a significant difference between group B and group B (P < 0.05), and the rate of clear uterus in group A was 95.35% (P < 0.05), and that in group B was 25.81% (P < 0.05). Conclusion. The uneven echo mass in uterine cavity after medical abortion should be removed by surgery or drugs. Color Doppler ultrasound (CDFI) is of great significance in monitoring blood flow signal. It is of great significance for clinicians to further treatment. It can avoid complications such as surgical trauma and secondary infertility for patients who do not need to clear the uterus and only need further medication to discharge the residual decidua or blood clot out of the body.
【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R169.42

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