本文選題：早期先兆流產(chǎn) + 補(bǔ)腎活血方��； 參考：《黑龍江中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:本課題是以腎虛血瘀型早期先兆流產(chǎn)的妊婦為觀察對象,通過動(dòng)態(tài)觀察用藥過程中,患者治療前后臨床癥狀的變化及血清人絨毛膜促性腺激素(β-HCG)水平、孕酮(P)、雌二醇(E2)及盆腔彩超的情況,以此來評(píng)估地屈孕酮聯(lián)合補(bǔ)腎活血方治療腎虛血瘀型早期先兆流產(chǎn)的臨床治療效果;連續(xù)監(jiān)測懷孕初期血清Ca125的水平,通過它的變化,來探求其在早期先兆流產(chǎn)時(shí)的變化規(guī)律,探析血清Ca125的水平升高在判斷早期前兆流產(chǎn)妊娠結(jié)局中的診斷價(jià)值。方法:選擇符合腎虛血瘀型早期先兆流產(chǎn)診斷標(biāo)準(zhǔn)的患者40例,給予西藥地屈孕酮10mg,日三次口服,同時(shí)配合中藥補(bǔ)腎活血方口服,3周為一個(gè)療程,觀察患者治療前后臨床癥狀的改善情況,通過動(dòng)態(tài)監(jiān)測血清P、E2、β-HCG水平變化,盆腔彩超來觀察胚胎發(fā)育情況,同時(shí)監(jiān)測血清Ca125的動(dòng)態(tài)水平變化,觀察它在孕期的變化規(guī)律,及其與妊娠結(jié)局的關(guān)系。結(jié)果:1、經(jīng)治療后,40例臨床患者臨床療效如下:痊愈5例(12.5%),顯效26例(65%),有效5例(12.5%),無效4例(10%),總有效率90%。2、治療前后患者的各個(gè)臨床癥候、病情程度、癥候積分的對比,P值均小于0.05,說明治療前后具有顯著性差別,患者的臨床均得到了明顯的改善。3、經(jīng)χ2檢驗(yàn),患者既往流產(chǎn)次數(shù)與臨床的綜合療效存在相關(guān)性(P0.05),提示流產(chǎn)的次數(shù)越多,患者的治療效果越差。4、患者妊娠后陰道出血時(shí)間與臨床的綜合療效存在相關(guān)性(P0.05),陰道出血時(shí)間越短,患者治療效果越好。5、患者治療前后病情程度與綜合療效存在相關(guān)性(P0.05),患者病情越輕,患者治療效果越好。6、治療后血清P、E2、β-HCG均有不同程度變化,繼續(xù)妊娠者治療前后激素水平相比上升明顯,妊娠失敗組治療前后相比上升不明顯甚至有所下降。7、孕早期出現(xiàn)先兆流產(chǎn)癥狀的孕婦血清Ca125均有不同程度的升高,經(jīng)治療后,繼續(xù)妊娠者血清Ca125水平下降明顯,與治療前具有顯著性差異(P0.05),而妊娠失敗者血清Ca125水平與治療前相比下降不明顯甚至有所上升。8、經(jīng)方差分析,有陰道出血癥狀的患者血清Ca125水平升高較無陰道出血的患者明顯,且出血時(shí)間越長,血清Ca125水平升高越明顯(p0.001)。結(jié)論:1、地屈孕酮聯(lián)合補(bǔ)腎活血方能夠有效治療腎虛血瘀型早期先兆流產(chǎn),能明顯改善陰道流血、腰酸脹痛,腹痛等臨床癥狀,保胎效果顯著。2、動(dòng)態(tài)監(jiān)測血清Ca125水平變化,對于早期先兆流產(chǎn)的風(fēng)險(xiǎn)評(píng)估有一定的臨床參考價(jià)值。
[Abstract]:Objective: To evaluate the changes of clinical symptoms and serum human chorionic gonadotropin (beta -HCG) levels, progesterone (P), estradiol (E2) and pelvic color Doppler before and after the treatment of pregnant women with Early Threatened Abortion of kidney deficiency and blood stasis, and evaluate the combination of progesterone (P), estradiol (E2) and pelvic cavity color Doppler. The clinical treatment effect of the Early Threatened Abortion of kidney deficiency and blood stasis type, the level of serum Ca125 in the early stage of pregnancy was continuously monitored, and the change of it was used to explore the changes in the early threatened abortion, and to explore the diagnostic value of the level of serum Ca125 in judging the outcome of Early Threatened Abortion pregnancy. 40 cases of the diagnosis standard of Early Threatened Abortion of blood stasis were given to 40 cases of Western medicine, three times on daily oral administration of tonifying kidney and activating blood, 3 weeks as a course of treatment. The improvement of clinical symptoms before and after treatment was observed. The changes of serum P, E2, beta -HCG and pelvic color Doppler ultrasound were used to observe the development of embryo. The changes in the dynamic level of serum Ca125 were monitored and the relationship between the changes in pregnancy and pregnancy outcome was observed. Results: 1, after treatment, the clinical effects of 40 patients were cured as follows: 5 cases (12.5%), 26 cases (65%), 5 effective (12.5%), 4 cases (10%), total effective rate of 90%.2, all clinical symptoms before and after treatment, the condition of the patients before and after treatment, the condition of the patients, the condition of the patients before and after treatment, the condition of the patients before and after treatment, the condition of the patients before and after treatment, the condition of the patients before and after treatment, the condition of the patients before and after treatment, the condition of the patients before and after treatment, the condition of the patients before and after treatment, the condition of the patients before and after treatment, the condition of the patients before and after treatment, the condition of the patients before and after treatment, the condition of the patients before and after treatment, the condition of the patients before and after treatment, the condition of the patients before and after treatment, and the condition of the patients before and after treatment. Degree, syndrome score comparison, P value is less than 0.05, indicating a significant difference before and after treatment, the patient's clinical has been significantly improved.3, the x 2 test, the number of previous miscarriages in patients with the clinical comprehensive effect has a correlation (P0.05), the more the number of abortion, the more poor treatment of the patient.4, the patient vagina after pregnancy out of the vagina There is a correlation between the blood time and the comprehensive clinical effect (P0.05). The shorter the vaginal bleeding time, the better the treatment effect of the patients.5, the patient's condition degree and the comprehensive effect before and after treatment (P0.05), the less the patient's condition, the better the treatment effect of the patient.6, after the treatment, the blood clear P, E2, beta -HCG all have different degree changes, continue the pregnancy before the treatment of the patients before treatment. Compared with the increase of post hormone levels, the increase of the serum Ca125 in pregnant women with threatened abortion in the early pregnancy was.7, and the serum Ca125 level of the pregnant women in the early pregnancy was significantly lower than that before the treatment (P0.05). The level of serum Ca125 in the patients was not obvious or even higher than that before the treatment. After the analysis of variance, the level of serum Ca125 in patients with vaginal bleeding symptoms was higher than those without vaginal bleeding, and the longer the bleeding time was, the higher the level of serum Ca125 increased (p0.001). 1, the combination of progesterone and kidney invigorating blood can be effectively treated. The early threatened abortion with kidney deficiency and blood stasis can obviously improve the clinical symptoms such as vaginal bleeding, low back distention and pain, abdominal pain and so on. The effect of fetal protection is.2, and the change of serum Ca125 level is monitored dynamically. It has certain clinical reference value for the risk assessment of early threatened abortion.
【學(xué)位授予單位】：黑龍江中醫(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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