補(bǔ)腎化瘀方預(yù)防IUA術(shù)后再粘連療效觀察及IUA危險因素分析
發(fā)布時間：2018-07-20 21:45
【摘要】：目的：本課題通過流行病學(xué)調(diào)查初步探討珠三角地區(qū)引起宮腔粘連(Intrauterine Adhesion, IUA)的可能相關(guān)危險因素。并且運(yùn)用婦科經(jīng)驗方補(bǔ)腎化瘀方聯(lián)合宮腔粘連分離術(shù)治療宮腔粘連所致的月經(jīng)過少甚則閉經(jīng)的相關(guān)癥狀,觀察本方藥對預(yù)防宮腔粘連患者經(jīng)TCRA術(shù)后再發(fā)生粘連的臨床療效。方法：1.納入2014年6月至2016年1月于我院住院且符合宮腔粘連診斷標(biāo)準(zhǔn)的病例148例,同時期至我院體檢的正常健康女性84例選為健康對照組。通過自行設(shè)計的宮腔粘連危險因素流行病學(xué)問卷進(jìn)行調(diào)查,對兩組人群的基線資料、生活習(xí)慣、飲食習(xí)慣、心理情志因素、孕產(chǎn)史、婦科疾病史、子宮體積大小等各因素進(jìn)行記錄、數(shù)據(jù)管理及統(tǒng)計分析。2.按照西醫(yī)和中醫(yī)(腎虛血瘀型)的診斷標(biāo)準(zhǔn),于2014年6月1日-2016年1月1日間在我院住院病人選擇合格受試者的42例患者按照臨床簡單隨機(jī)對照試驗分為兩組,進(jìn)行前瞻性觀察研究：①對照組22例：TCRA術(shù)后上節(jié)育環(huán),聯(lián)合補(bǔ)佳樂(2mgbid 21天)+達(dá)芙通(10mg bid后10天)；②治療組20例：在對照組的基礎(chǔ)上加服補(bǔ)腎化瘀方中藥(每日1劑,經(jīng)期停服)。分別治療3個月經(jīng)周期。治療過程中,通過對治療前后中醫(yī)證候評分、宮腔粘連評分和B超監(jiān)測的子宮內(nèi)膜厚度及不良反應(yīng)進(jìn)行臨床觀察,評價藥物的有效性及安全性。結(jié)果：1.宮腔粘連危險因素研究結(jié)果：通過問卷調(diào)查表發(fā)放方式,采用卡方檢驗、t檢驗、二元逐步Logistic回歸分析,單因素分析顯示宮腔粘連的發(fā)生與年齡、焦慮、急躁、嗜食辛辣、經(jīng)期吃寒涼食物、熬夜、經(jīng)期行房、運(yùn)動、經(jīng)期保暖、孕次、產(chǎn)次、人流、宮腔操作次數(shù)、婦科炎性疾病、首次性生活年齡、子宮體積大小存在相關(guān)性,與身高、體重、BMI、婚姻情況、文化程度、收入情況、憂思、抑郁、經(jīng)期吃水果、刻意節(jié)食、自然流產(chǎn)次、藥流次數(shù)、器質(zhì)性病變、避孕方式無相關(guān)性；將單因素分析中存在相關(guān)性的因素重新進(jìn)行逐步Logistic回歸模型多因素分析,顯示經(jīng)期吃寒涼食物、焦慮、熬夜、經(jīng)期行房、孕次、人流次數(shù)、宮腔操作次數(shù)、子宮體積大小、婦科炎性疾病與宮腔粘連呈正相關(guān),考慮為宮腔粘連發(fā)病的獨(dú)立危險因素。2.補(bǔ)腎化瘀方預(yù)防宮腔粘連術(shù)后再粘連臨床療效結(jié)果：(1)中醫(yī)整體療效比較,治療組總有效率為95%,對照組86.4%,經(jīng)檢驗治療組療效優(yōu)于對照組。組內(nèi)治療前后比較差異有統(tǒng)計學(xué)意義(P0.05),提示兩組療后證候療效較療前改善。組間比較經(jīng)獨(dú)立樣本t檢驗,第1周期兩組積分無差異(P0.05),治療第2、3周期兩組積分差異有顯著性意義(P0.05),提示治療組對證候的改善優(yōu)于對照組。(2)治療組在中醫(yī)主癥的經(jīng)量及經(jīng)色質(zhì)方面的治療總有效率分別為95%、94.74%,對照組分別為83.33%、75%,經(jīng)檢驗差異有統(tǒng)計學(xué)意義(P0.05)；兩組的月經(jīng)經(jīng)行時間差異無統(tǒng)計學(xué)意義。(3)IUA評分兩組治療前后比較差異有統(tǒng)計學(xué)意義(P0.05),說明兩組治療方案對宮腔粘連術(shù)后再粘連均有效,治療后兩組間IUA評分對比及兩組治療前后IUA評分差值比較,差異均有統(tǒng)計學(xué)意義(P0.05),提示聯(lián)合中藥治療組預(yù)防再粘連療效更顯著。(4)治療后兩組患者B超內(nèi)膜厚度與治療前比較差異有統(tǒng)計學(xué)意義(P0.05),治療后組間內(nèi)膜厚度比較及兩組治療前后內(nèi)膜厚度差值比較差異無統(tǒng)計學(xué)意義(P0.05),提示兩組治療方案對改善內(nèi)膜增厚療效相當(dāng)。結(jié)論：初步了解到與宮腔粘連的發(fā)病可能相關(guān)的因素有經(jīng)期吃寒涼食物、焦慮、熬夜、經(jīng)期行房、孕次、人流次數(shù)、宮腔操作次數(shù)、子宮大小、婦科炎性疾病,其中情志方面的焦慮、人流次數(shù)、宮腔操作次數(shù)及婦科炎性疾病為高發(fā)危險因素。補(bǔ)腎化瘀方能夠有效地預(yù)防宮腔粘連松解術(shù)后再粘連,能夠更好地改善月經(jīng)的經(jīng)量和色質(zhì),總而言之,補(bǔ)腎化瘀方是安全有效的,值得推廣。
[Abstract]:Objective: To investigate the possible risk factors of Intrauterine Adhesion (IUA) in the Pearl River Delta region by epidemiological investigation, and to observe the related symptoms of less menstrual amenorrhea caused by intrauterine adhesions in the treatment of intrauterine adhesions by gynecologic experience. The clinical effect of preventing adhesions in patients with intrauterine adhesions after TCRA. Methods: 1.: 148 cases were hospitalized in our hospital from June 2014 to January 2016 and conformed to the diagnostic criteria of intrauterine adhesions. 84 normal healthy women at the same time to our hospital were selected as the healthy control group. The risk factors of intrauterine adhesions were designed by ourselves. A questionnaire was conducted to record the baseline data, living habits, dietary habits, psychological factors, pregnancy history, gynecologic disease history, and the size of the uterus in two groups of people. Data management and statistical analysis of.2. were in accordance with the diagnostic criteria of Western medicine and traditional Chinese medicine (kidney deficiency and blood stasis) in January, June 1, 2014, and 1 days in January. 42 cases of hospitalized patients selected qualified subjects were divided into two groups according to the clinical simple randomized controlled trial. There were 22 cases in the control group: 22 cases in the control group: after TCRA, combined with 2mgbid (21 days) + Duff (10 days after 10mg bid); and (2) the treatment group 20 cases were added to the control group on the basis of the kidney and Huayu Prescription. Chinese medicine (1 doses per day, menstrual stop). Treatment of 3 menstrual cycles respectively. In the course of treatment, clinical observation of TCM syndrome scores, uterine adhesion score, endometrial thickness and adverse reactions monitored by B ultrasonic examination, evaluation of the efficacy and safety of drugs. Results of study on the risk factors of 1. intrauterine adhesions: through inquiry Method of questionnaire survey, using chi square test, t test, two yuan gradually Logistic regression analysis, single factor analysis showed the occurrence of uterine adhesion and age, anxiety, irritability, hot food, eating cold food, stay up late, menstrual room, exercise, menstrual warm, pregnancy, birth, abortion, uterine operation times, gynecologic inflammatory diseases, the first sex Living age, the size of the uterus was related, with height, weight, BMI, marital status, educational level, income, anxiety, depression, eating fruit, deliberate dieting, spontaneous abortion, drug flow times, organic diseases, contraceptive methods, and the correlation factors in the single factor analysis were re carried out in the progressive Logistic regression model. Model multi factor analysis showed that eating cold and cold food, anxiety, staying up late, menstrual travel, pregnancy times, number of people, uterine cavity operation times, uterus size, gynecological inflammatory disease and uterine adhesion are positively related, considering the independent risk factor of intrauterine adhesion,.2. tonifying kidney and removing blood stasis to prevent adhesion after uterine cavity adhesion clinical curative effect results: 1) the overall curative effect of traditional Chinese medicine was compared, the total effective rate of the treatment group was 95%, the control group was 86.4%, the curative effect of the treatment group was better than the control group. The difference in the treatment group was statistically significant before and after the treatment (P0.05), suggesting that the curative effect of the two groups was better than that before the treatment. The group was compared with the independent sample t test, the first cycle two groups had no difference (P0.05), and the treatment of the third group. There were significant differences between the two groups of the period (P0.05), suggesting that the improvement of the syndrome in the treatment group was better than the control group. (2) the total effective rate of treatment in the treatment group was 95%, 94.74%, and the control group was 83.33%, 75% respectively, and the difference was statistically significant (P0.05) in the control group, and the menstrual period difference between the two groups was different. There was no statistical significance. (3) there was a significant difference between the two groups of IUA scores before and after treatment (P0.05), indicating that the two groups of treatment schemes were effective for postoperative adhesions after intrauterine adhesions, and the difference between the two groups after the treatment and the difference values of the two groups before and after the treatment of the two groups were statistically significant (P0.05), suggesting that the combined Chinese medicine treatment group could prevent the recurrence. The effect of adhesion was more significant. (4) there was a significant difference in the thickness of the endometrium in the two groups after treatment (P0.05). The comparison of the thickness of the endometrium between the groups after treatment and the difference of the thickness of the endometrium between the two groups before and after treatment was not statistically significant (P0.05), suggesting that the curative effect of the treatment regimen in the two groups was equivalent to the improvement of the intimal thickening. Conclusion: preliminary conclusion: The factors that may be related to the pathogenesis of adhesion to the uterine cavity include eating cold and cold food, anxiety, staying up late, menstrual travel, pregnancy times, number of people, uterine cavity operation times, uterus size, gynecological inflammatory disease, anxiety of the womb, number of people, times of human flow, times of uterine cavity operation and inflammatory diseases of gynecology. Effective prevention of adhesions after uterine cavity adhesions can better improve menstrual volume and color quality. In a word, it is safe and effective to make up the kidney and removing stasis. It is worth promoting.
【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】：2016
【分類號】：R271.9
本文編號：2134887
[Abstract]:Objective: To investigate the possible risk factors of Intrauterine Adhesion (IUA) in the Pearl River Delta region by epidemiological investigation, and to observe the related symptoms of less menstrual amenorrhea caused by intrauterine adhesions in the treatment of intrauterine adhesions by gynecologic experience. The clinical effect of preventing adhesions in patients with intrauterine adhesions after TCRA. Methods: 1.: 148 cases were hospitalized in our hospital from June 2014 to January 2016 and conformed to the diagnostic criteria of intrauterine adhesions. 84 normal healthy women at the same time to our hospital were selected as the healthy control group. The risk factors of intrauterine adhesions were designed by ourselves. A questionnaire was conducted to record the baseline data, living habits, dietary habits, psychological factors, pregnancy history, gynecologic disease history, and the size of the uterus in two groups of people. Data management and statistical analysis of.2. were in accordance with the diagnostic criteria of Western medicine and traditional Chinese medicine (kidney deficiency and blood stasis) in January, June 1, 2014, and 1 days in January. 42 cases of hospitalized patients selected qualified subjects were divided into two groups according to the clinical simple randomized controlled trial. There were 22 cases in the control group: 22 cases in the control group: after TCRA, combined with 2mgbid (21 days) + Duff (10 days after 10mg bid); and (2) the treatment group 20 cases were added to the control group on the basis of the kidney and Huayu Prescription. Chinese medicine (1 doses per day, menstrual stop). Treatment of 3 menstrual cycles respectively. In the course of treatment, clinical observation of TCM syndrome scores, uterine adhesion score, endometrial thickness and adverse reactions monitored by B ultrasonic examination, evaluation of the efficacy and safety of drugs. Results of study on the risk factors of 1. intrauterine adhesions: through inquiry Method of questionnaire survey, using chi square test, t test, two yuan gradually Logistic regression analysis, single factor analysis showed the occurrence of uterine adhesion and age, anxiety, irritability, hot food, eating cold food, stay up late, menstrual room, exercise, menstrual warm, pregnancy, birth, abortion, uterine operation times, gynecologic inflammatory diseases, the first sex Living age, the size of the uterus was related, with height, weight, BMI, marital status, educational level, income, anxiety, depression, eating fruit, deliberate dieting, spontaneous abortion, drug flow times, organic diseases, contraceptive methods, and the correlation factors in the single factor analysis were re carried out in the progressive Logistic regression model. Model multi factor analysis showed that eating cold and cold food, anxiety, staying up late, menstrual travel, pregnancy times, number of people, uterine cavity operation times, uterus size, gynecological inflammatory disease and uterine adhesion are positively related, considering the independent risk factor of intrauterine adhesion,.2. tonifying kidney and removing blood stasis to prevent adhesion after uterine cavity adhesion clinical curative effect results: 1) the overall curative effect of traditional Chinese medicine was compared, the total effective rate of the treatment group was 95%, the control group was 86.4%, the curative effect of the treatment group was better than the control group. The difference in the treatment group was statistically significant before and after the treatment (P0.05), suggesting that the curative effect of the two groups was better than that before the treatment. The group was compared with the independent sample t test, the first cycle two groups had no difference (P0.05), and the treatment of the third group. There were significant differences between the two groups of the period (P0.05), suggesting that the improvement of the syndrome in the treatment group was better than the control group. (2) the total effective rate of treatment in the treatment group was 95%, 94.74%, and the control group was 83.33%, 75% respectively, and the difference was statistically significant (P0.05) in the control group, and the menstrual period difference between the two groups was different. There was no statistical significance. (3) there was a significant difference between the two groups of IUA scores before and after treatment (P0.05), indicating that the two groups of treatment schemes were effective for postoperative adhesions after intrauterine adhesions, and the difference between the two groups after the treatment and the difference values of the two groups before and after the treatment of the two groups were statistically significant (P0.05), suggesting that the combined Chinese medicine treatment group could prevent the recurrence. The effect of adhesion was more significant. (4) there was a significant difference in the thickness of the endometrium in the two groups after treatment (P0.05). The comparison of the thickness of the endometrium between the groups after treatment and the difference of the thickness of the endometrium between the two groups before and after treatment was not statistically significant (P0.05), suggesting that the curative effect of the treatment regimen in the two groups was equivalent to the improvement of the intimal thickening. Conclusion: preliminary conclusion: The factors that may be related to the pathogenesis of adhesion to the uterine cavity include eating cold and cold food, anxiety, staying up late, menstrual travel, pregnancy times, number of people, uterine cavity operation times, uterus size, gynecological inflammatory disease, anxiety of the womb, number of people, times of human flow, times of uterine cavity operation and inflammatory diseases of gynecology. Effective prevention of adhesions after uterine cavity adhesions can better improve menstrual volume and color quality. In a word, it is safe and effective to make up the kidney and removing stasis. It is worth promoting.
【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】：2016
【分類號】：R271.9
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