發(fā)布時間：2017-12-27 11:00

  本文關(guān)鍵詞：溫針灸督脈治療腎虛血瘀型多囊卵巢綜合征不孕的臨床研究　出處：《廣州中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 溫針灸督脈 腎虛血瘀型 多囊卵巢綜合征 不孕

【摘要】：目的:觀察溫針灸督脈對腎虛血瘀型多囊卵巢綜合征不孕的臨床療效,旨在充分發(fā)揮中醫(yī)特色,為多囊卵巢綜合征不孕的治療增添新的思路和方法。方法:采用隨機(jī)對照研究方法,將符合條件的60例腎虛血瘀型多囊卵巢綜合征不孕患者,隨機(jī)分為治療組(溫針灸督脈)和對照組(克羅米芬)各30例。治療組:運用溫針灸督脈(百會、大椎、身柱、至陽、命門、腰陽關(guān)、十七椎、腎俞(雙側(cè)),穴位處常規(guī)消毒,常規(guī)針刺法得氣后,針身上添加薄紙皮,且于針柄插入點燃艾柱,所有穴位均行溫針灸2壯,時間約30min。自月經(jīng)第5天(自然周期或口服黃體酮膠丸100mg bid 5天撤退出血)開始治療,隔日治療1次,1個月經(jīng)周期為1個療程,直到下次月經(jīng)來潮停止針灸,經(jīng)期禁止針灸。針對照組:月經(jīng)周期第5天(自然周期或口服黃體酮膠丸100mg bid 5天撤退出血)開始服用克羅米芬50mg/d×5天。2組患者均在月經(jīng)期第10、12、14天行陰道B超監(jiān)測卵泡發(fā)育情況,當(dāng)B超監(jiān)測卵泡直徑達(dá)18～25mm形成優(yōu)勢卵泡時,配合肌肉注射人絨毛膜促性腺素(HCG)10000U,并指導(dǎo)同房。2組治療療程為均3個月經(jīng)周期,一旦受孕即停止治療。觀察比較2組患者的BMI、中醫(yī)臨床癥候、性激素、卵泡發(fā)育、排卵情況、妊娠率等相關(guān)指標(biāo),運用統(tǒng)計學(xué)方法分析兩組實驗數(shù)據(jù),得出結(jié)論。評價溫針灸督脈的臨床療效。結(jié)果:1.一般基礎(chǔ)情況比較治療前兩組年齡、病程比較,P值均0.05,差異無統(tǒng)計學(xué)意義,說明兩組基線水平具有可比性。2.臨床療效觀察(1)臨床總療效分析治療組總療效率86.66%,對照組總療效率60%,兩組比較P0.05,無統(tǒng)計學(xué)意義。說明兩組在總的療效方面相同。(2)中醫(yī)癥候積分、中醫(yī)療效分析治療前兩組中醫(yī)癥候積分、中醫(yī)療效比較,均無統(tǒng)計學(xué)意義(P0.05)。治療后中醫(yī)積分的中位數(shù)治療組4低于對照組5,具有顯著性差異(P0.05)。治療后中醫(yī)療效治療組有效率83.33%高于對照組70%,具有顯著性差異(P0.05)。說明治療組在改善中醫(yī)癥候、中醫(yī)療效方面優(yōu)于對照組。中醫(yī)積分治療前后差值t=2.251,p=0.029,說明治療后兩組中醫(yī)癥候比較有明顯性差異,溫針灸督脈組優(yōu)于西藥組。(3)BMI分析治療前兩組BMI比較P0.05,差異無統(tǒng)計學(xué)意義,說明兩組具有可比性。治療后與治療前兩組內(nèi)比較有顯著性差異(P0.01,治療前后差值比較,P0.01,說明治療后兩組間比較具有統(tǒng)計學(xué)意義(P0.05),治療組在改善患者BMI方面優(yōu)于對照組。(4)性激素分析治療前兩組性激素比較均0.05,差異無統(tǒng)計學(xué)意義,說明兩組具有可比性。治療后兩組性激素比較,LH、LH/FSH比較P0.05差異有統(tǒng)計學(xué)意義;其余FSH、T比較P0.05,差異無統(tǒng)計學(xué)意義。2組治療前后差值LH比較P0.05,具有統(tǒng)計學(xué)意義,其余均P0.05,差異無統(tǒng)計學(xué)意義。提示溫針灸督脈組在改善性激素值方面優(yōu)于對照組。說明溫針灸督脈能調(diào)節(jié)HP0A軸,促進(jìn)下丘腦-垂體-卵巢功能恢復(fù),從而有助于成熟卵泡的發(fā)育及子宮內(nèi)膜生長,提高排卵率及妊娠率。(5)卵泡大小、子宮內(nèi)膜厚度分析治療前兩組卵泡大小、子宮內(nèi)膜厚度比較PO.05,差異無統(tǒng)計學(xué)意義,說明兩組具有可比性。治療后兩組卵泡大小、子宮內(nèi)膜厚度比較P0.05,且在治療前后差值,卵泡大小、子宮內(nèi)膜厚度p=0.000,兩組具有明顯差異性,具有統(tǒng)計學(xué)意義,治療組優(yōu)于對照組。(6)排卵次數(shù)分析在治療期間,兩組在排卵次數(shù)方面,溫針灸督脈具有同等克羅米芬的治療效果,二者無統(tǒng)計學(xué)差異(P0.05)。(7)妊娠率分析:治療后,治療組妊娠率40%,妊娠人數(shù)12人;對照組,妊娠率23.33%,妊娠人數(shù)7人,治療組高于對照組,兩組患者的妊娠率比較無統(tǒng)計學(xué)意義(P0.05)。說明兩組在妊娠結(jié)局方面療效相同。結(jié)論:溫針灸督脈治療腎虛血瘀型多囊卵巢綜合征性不孕,總的臨床療效、排卵次數(shù)、妊娠率等同于克羅米芬。但在減輕體重指數(shù)、改善中醫(yī)癥候、性激素、增加子宮內(nèi)膜厚度及卵泡大小方面較西藥有優(yōu)勢;顯示了針灸治療本病的優(yōu)越性,為中醫(yī)辨證治療本病提供客觀依據(jù)。
[Abstract]:Objective: To observe the clinical curative effect of acupuncture and moxibustion on Du Meridian of polycystic ovarian syndrome with infertility, to give full play to the characteristics of traditional Chinese medicine, treatment for infertile women with polycystic ovary syndrome add new ideas and methods. Methods: a randomized controlled study method, will meet the conditions of the 60 cases of polycystic ovarian syndrome with infertility patients were randomly divided into treatment group (acupuncture Du Meridian) and control group (J Romy Finn) 30 cases. The treatment group: the use of acupuncture and moxibustion on Baihui and Dazhui (DU, column, to Yang, Mingmen, Yaoyangguan, seventeen vertebrae, Shenshu (bilateral) acupoints, routine disinfection, routine acupuncture method gas, needle body and needle to add skin tissue, handle is inserted into the ignited moxa, all points for acupuncture and moxibustion 2 strong, time is about 30min. Since the fifth day of the menstrual cycle (natural cycle or oral administration of Progesterone Soft Capsules 100mg bid 5 days withdrawal bleeding) started treatment, every other day for 1 times, 1 menstrual cycles for 1 course, until the next menstrual period to stop acupuncture, acupuncture is prohibited. The control group: the fifth day of menstrual cycle (natural cycle or oral administration of Progesterone Soft Capsules 100mg bid 5 days withdrawal bleeding) started taking clomiphene 50mg/d * 5 days. 2 groups of patients in the tenth, twelfth, fourteenth days of menstruation, vaginal ultrasound monitoring follicular development, when B-mode ultrasound monitoring follicular diameter of 18 ~ 25mm to form dominant follicles, combined with intramuscular injection of human chorionic gonadotrophin (HCG) 10000U, and guide the same room. The treatment course of the 2 groups was 3 menstrual cycles, and once the pregnancy was stopped, the treatment was stopped. The BMI, TCM clinical symptoms, sex hormones, follicular development, ovulation and pregnancy rate of 2 groups of patients were observed and compared. The two groups of experimental data were analyzed by statistical method, and the conclusion was drawn. To evaluate the clinical efficacy of warming acupuncture meridian. Results: 1. the comparison of the age and course of disease between the two groups before the treatment was compared, the P value was 0.05, the difference was not statistically significant, indicating that the baseline level of the two groups was comparable. 2. clinical curative effect observation (1) total clinical curative effect analysis treatment group total treatment efficiency 86.66%, the control group total treatment efficiency 60%, two groups compared P0.05, no statistical significance. The results showed that the two groups were the same in the total curative effect. (2) there was no statistical significance (P0.05) in the score of TCM syndrome and the curative effect of traditional Chinese medicine in the first two groups of TCM syndrome scores and the comparison of traditional Chinese medicine (TCM). After treatment, the median treatment group of traditional Chinese medicine score was 4 lower than that of the control group (5), with significant difference (P0.05). After treatment, the effective rate of the treatment group of Chinese medicine was 83.33% higher than that of the control group (70%), with significant difference (P0.05). It shows that the treatment group is better than the control group in improving the TCM syndrome and the curative effect of traditional Chinese medicine. Before and after the treatment of traditional Chinese medicine integral difference t=2.251 p=0.029, indicating the two groups after treatment of TCM symptoms comparison has the obvious difference, Du warm acupuncture group was better than control group. (3) before BMI analysis, two groups of BMI were compared with P0.05, and the difference was not statistically significant, indicating that the two groups were comparable. There was a significant difference between the two groups after treatment (P0.01), the difference between before and after treatment was P0.01, indicating that there was statistical significance between the two groups after treatment (P0.05), and the treatment group was better than the control group in improving BMI. (4) the sex hormone analysis before treatment of the two groups of sex hormones were 0.05, the difference was not statistically significant, indicating that the two groups were comparable. After treatment, the differences of LH and LH/FSH in the two groups were statistically significant, and the other FSH and T compared to P0.05, the difference was not statistically significant. The difference between the 2 groups before and after treatment was compared with P0.05, and the difference was statistically significant, the rest were P0.05, and the difference was not statistically significant. Warm acupuncture group in improvement of hormone values than the control group. That acupuncture and moxibustion can regulate the Du HP0A axis, promote the recovery of ovarian function of hypothalamic pituitary, which contributes to the development of mature follicle and endometrial growth, improve the ovulation rate and pregnancy rate. (5) follicle size and endometrial thickness were analyzed before treatment. There was no statistically significant difference in follicle size and endometrial thickness between the two groups before treatment. The difference between the two groups was not statistically significant, indicating that the two groups were comparable. After treatment, the follicle size and endometrial thickness of the two groups were P0.05 compared with that of the control group, and the difference between the two groups before and after treatment, the size of follicle and the thickness of endometrium were p=0.000. There was significant difference between the two groups, which was statistically significant, and the treatment group was better than the control group. (6) the number of ovulation during treatment, two groups in ovulation, warm acupuncture Du meridian has the same clomiphene treatment effect, no statistical difference between the two (P0.05). (7) pregnancy rate analysis: after treatment, the pregnancy rate of the treatment group was 40%, and the number of pregnant women was 12. In the control group, the pregnancy rate was 23.33%, the number of pregnant women was 7, the treatment group was higher than that of the control group, and the pregnancy rate of two groups was not statistically significant (P0.05). The results showed that the two groups had the same effect in the outcome of pregnancy. Conclusion: the syndrome infertility with acupuncture and moxibustion on treatment of polycystic ovary syndrome, the clinical efficacy, ovulation and pregnancy rate equivalent to clomiphene. But it has advantages in reducing body mass index, improving TCM symptoms, sex hormones, increasing endometrial thickness and follicle size, showing the superiority of acupuncture in treating this disease, and providing objective basis for TCM treatment based on syndrome differentiation.
【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】：R246.3

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