本文關(guān)鍵詞： 早期先兆流產(chǎn) 腎虛型 加味壽胎丸 保胎治療 妊娠結(jié)局　出處：《南京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的觀察加味壽胎丸治療腎虛型早期先兆流產(chǎn)的臨床療效,并對(duì)早期先兆流產(chǎn)患者保胎治療后的妊娠結(jié)局進(jìn)行研究。方法收集2015年4月-2016年4月在南京醫(yī)科大學(xué)附屬婦產(chǎn)醫(yī)院中醫(yī)科住院部行保胎治療的腎虛型早期先兆流產(chǎn)患者129例,隨機(jī)分為兩組,其中,中西醫(yī)結(jié)合保胎組66例,西藥保胎組63例。西藥保胎組給予口服地屈孕酮片,每次1Omg,每日3次;肌注黃體酮,每次20mg,每日1次。中西醫(yī)結(jié)合保胎組在西藥治療的基礎(chǔ)上,同時(shí)口服中藥治療,以加味壽胎丸治療,水煎服,每日一劑,早晚溫服。觀察兩組臨床療效及臨床癥候的改善情況。從臨床收集的治療病例中選取保胎后分娩的女性100例(中西醫(yī)結(jié)合保胎50例,西藥保胎50例)作為治療組,另隨機(jī)選取2015年4月-2016年4月在南京醫(yī)科大學(xué)附屬婦產(chǎn)醫(yī)院分娩的且無早期藥物保胎史的孕婦100例作為對(duì)照組,對(duì)治療組和對(duì)照組孕婦妊娠期及分娩期并發(fā)癥進(jìn)行統(tǒng)計(jì),包括早產(chǎn)、妊娠期高血壓、妊娠期糖尿病(GDM)、妊娠期肝內(nèi)膽汁淤積癥(ICP)、胎膜早破(PROM)、胎盤粘連、前置胎盤及產(chǎn)后出血(PPH)等情況;同時(shí)統(tǒng)計(jì)新生兒身體健康情況,包括新生兒畸形、新生兒窒息(死亡)、巨大兒及低體重兒等不良結(jié)局。結(jié)果中西醫(yī)結(jié)合保胎組痊愈38例,有效24例,無效4例,總有效率93.9%;西藥保胎組痊愈26例,有效25例,無效12例,總有效率81%。兩組療效相比差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。在治療后中醫(yī)癥候評(píng)分方面,中西醫(yī)結(jié)合保胎組優(yōu)于西藥保胎組,差異具有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。治療組在妊娠期及分娩期并發(fā)癥和新生兒不良結(jié)局方面與對(duì)照組相比較,除早產(chǎn)(P0.05)外,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1.加味壽胎丸治療腎虛型早期先兆流產(chǎn)療效可靠,在臨床療效、改善臨床癥候上優(yōu)于單純西藥保胎。2.有早期先兆流產(chǎn)史的婦女更易發(fā)生早產(chǎn),且早產(chǎn)孕周易發(fā)生于34-37周。3.早期先兆流產(chǎn)保胎治療后繼續(xù)妊娠未增加妊娠期高血壓、妊娠期糖尿病、妊娠期肝內(nèi)膽汁淤積癥、前置胎盤等妊娠期合并癥的發(fā)病率。4.早期先兆流產(chǎn)保胎治療后繼續(xù)妊娠未增加胎膜早破、產(chǎn)后出血、胎盤粘連等分娩期并發(fā)癥的發(fā)病率。5.早期先兆流產(chǎn)保胎治療后繼續(xù)妊娠未增加低體重兒、巨大兒、畸形、窒息、死亡等新生兒不良結(jié)局的發(fā)病率。
[Abstract]:Objective to observe the clinical effect of Jiawei Shoutai pill on early threatened abortion of kidney deficiency type. The pregnancy outcome of early threatened abortion patients after fetal preservation treatment was studied. Methods from April 2015 to April 2016 in the Department of traditional Chinese Medicine affiliated to Nanjing Medical University Department of Obstetrics and Gynecology Department of traditional Chinese Medicine Department of Fetal Preservation treatment of the kidney. 129 cases of early threatened abortion with deficiency type. They were divided randomly into two groups: 66 cases in the group of integrated traditional Chinese and western medicine and 63 cases in the group of keeping fetus with western medicine, and the other group was given oral diproprogesterone tablets 3 times a day, 1 Omg each time. Intramuscular injection of progesterone, 20 mg per day, once a day. The combination of traditional Chinese and Western medicine on the basis of the treatment of Western medicine, oral Chinese medicine treatment, with modified Shoutai pills treatment, water decoction, one dose per day. Morning and evening warm clothes. Observe the two groups of clinical efficacy and the improvement of clinical symptoms. From the clinical collection of cases selected from the treatment of 100 women born after fetal preservation (50 cases of integrated Chinese and Western medicine fetal preservation. 50 cases were treated with western medicine as treatment group. From April 2015 to April 2016, 100 pregnant women who had no early history of drug preservation were selected as control group, who were delivered in Department of Obstetrics and Gynecology Hospital of Nanjing Medical University from April 2015 to April 2016. The complications of pregnancy and delivery in treatment group and control group were analyzed, including premature delivery, gestational hypertension, gestational diabetes mellitus (GDMN), intrahepatic cholestasis of pregnancy (ICP). Premature rupture of membranes (Prom), placental adhesion, placenta previa and postpartum hemorrhage (PPH); At the same time, the physical health of the newborn was counted, including neonatal malformation, neonatal asphyxia (death, macrosomia and low birth weight) and other adverse outcomes. Results 38 cases were cured and 24 cases were effective in the group of integrated traditional Chinese and western medicine. 4 cases were ineffective, the total effective rate was 93.9%; 26 cases were cured, 25 cases were effective, 12 cases were ineffective, and the total effective rate was 81%. The difference between the two groups was statistically significant (P 0.05). The combination of traditional Chinese and Western medicine group is better than the Western medicine group, the difference is statistically significant. The treatment group in pregnancy and childbirth complications and neonatal adverse outcome compared with the control group. Except preterm birth (P0.05), the difference was not statistically significant (P 0.05). Conclusion 1. The effect of Jiawei Shoutai pills on early threatened abortion of kidney deficiency type is reliable, and it is effective in clinical practice. 2. The improvement of clinical symptoms is better than that of simple western medicine. 2. Women with a history of early threatened abortion are more likely to have premature delivery. And preterm gestational weeks are prone to occur in 34-37 weeks. 3. Early threatened abortion and fetal preservation treatment continued pregnancy did not increase gestational hypertension, gestational diabetes, intrahepatic cholestasis of pregnancy. Placenta previa and other complications of pregnancy incidence. 4. Early threatened abortion after fetal treatment continued pregnancy did not increase premature rupture of membranes, postpartum hemorrhage. Incidence of complications during delivery such as placenta adhesion. 5. Incidence of adverse outcomes of newborns such as low birth weight, macrosomia, malformation, asphyxia, death and so on.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R271.9

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