【摘要】：目的：觀察滋腎寧心湯治療應(yīng)用GnRH-a后出現(xiàn)類絕經(jīng)期癥狀且中醫(yī)辨證屬于腎陰虛證的子宮內(nèi)膜異位癥術(shù)后患者的中醫(yī)臨床癥狀療效、絕經(jīng)癥狀嚴(yán)重程度、各項(xiàng)癥狀的發(fā)生率及不良反應(yīng)等。探討滋腎寧心湯治療應(yīng)用GnRH-a致類絕經(jīng)期癥狀的子宮內(nèi)膜異位癥術(shù)后患者的臨床療效,為子宮內(nèi)膜異位癥術(shù)后應(yīng)用GnRH-a后出現(xiàn)類絕經(jīng)期癥狀的治療提供臨床研究依據(jù)。方法：本研究選取病例均來自2014年01月01日至2016年05月31日于南京中醫(yī)藥大學(xué)附屬中西醫(yī)結(jié)合醫(yī)院行腹腔鏡手術(shù)且病理確診為子宮內(nèi)膜異位癥,術(shù)后應(yīng)用促性腺激素釋放激素激動(dòng)劑(GnRH-a)治療時(shí)出現(xiàn)類絕經(jīng)期癥狀的且中醫(yī)辨證屬腎陰虛證的患者100例(對(duì)照組35例,坤泰組32例,中藥組33例),隨機(jī)分為3組,排除脫落病例,最終完成每組各30例。所有患者均于術(shù)后月經(jīng)周期第1天給予GnRH-a注射(戈舍瑞林3.6mg皮下注射),每28天注射1次,共4次。對(duì)照組僅予GnRH-a注射,坤泰組、中藥組分別于第二次給予GnRH-a同時(shí)加用坤泰膠囊、中藥方滋腎寧心湯,每四周為一個(gè)療程,共三個(gè)療程；比較三組患者在應(yīng)用坤泰膠囊或滋腎寧心湯治療前后中醫(yī)臨床癥狀療效評(píng)價(jià)、絕經(jīng)癥狀評(píng)分及不良反應(yīng)。結(jié)果：1.三組患者治療后第12周相比,坤泰組及中藥組均較同組治療前臨床癥狀及體征積分明顯下降,差異有統(tǒng)計(jì)學(xué)意義(p0.05),而對(duì)照組與治療前比較差異無統(tǒng)計(jì)學(xué)意義(p0.05)。治療后第12周三組Kupermann評(píng)分均較同組治療前升高,且按對(duì)照組、坤泰組、中藥組的順序依次呈下降趨勢(shì),且差異具有的統(tǒng)計(jì)學(xué)意義(p0.05)。2.對(duì)照組在治療期間出現(xiàn)了一系列的類絕經(jīng)期癥狀,坤泰組及中藥組相應(yīng)癥狀出現(xiàn)的例數(shù)均有所減少,且中藥組與坤泰組相比其類絕經(jīng)期癥狀的嚴(yán)重程度明顯較輕。結(jié)論：滋腎寧心湯在臨床上可有效緩解子宮內(nèi)膜異位癥術(shù)后患者應(yīng)用促性腺激素釋放激素激動(dòng)劑(GnRH-a)治療所引起的類絕經(jīng)期癥狀,且療效優(yōu)于坤泰膠囊。
[Abstract]:Objective: to observe the effect of Zishen Ningxin decoction on the clinical symptoms and the severity of menopausal symptoms in patients with endometriosis with syndrome differentiation of kidney yin deficiency after GnRH-a. Incidence of symptoms and adverse reactions. To explore the clinical effect of Zishen Ningxin decoction in treating endometriosis patients with menopausal symptoms caused by GnRH-a, and to provide clinical research basis for the treatment of menopausal symptoms after GnRH-a. Methods: all cases were selected from January 01, 2014 to May 31, 2016 in Nanjing University of traditional Chinese Medicine affiliated to the hospital of integrated traditional Chinese and western medicine laparoscopic surgery and pathological diagnosis of endometriosis, After operation, 100 patients (35 cases in control group, 32 cases in Kuntai group and 33 cases in Chinese herbal medicine group) who had postmenopausal symptoms of gonadotropin releasing hormone agonist (GnRH-a) were randomly divided into 3 groups, excluding shedding cases. 30 cases in each group were finished. All patients were given GnRH-a injection (3.6mg subcutaneous injection) on the first day of menstrual cycle after operation, once every 28 days, a total of 4 times. The control group was only given GnRH-a injection, the Kun Tai group and the traditional Chinese medicine group were given GnRH-a plus Kun Tai capsule for the second time. The traditional Chinese medicine prescription Zishen Ningxin decoction was a course of treatment every four weeks for a total of three courses. To compare the curative effect evaluation, menopausal symptom score and adverse reaction of TCM before and after the treatment with Kun Tai capsule or Zishen Ningxin decoction. The result is 1: 1. At the 12th week after treatment, the scores of clinical symptoms and signs in Kuntai group and traditional Chinese medicine group were significantly lower than those in the same group (p0.05), but there was no significant difference between control group and pre-treatment group (p0.05). The Kupermann scores in the 12th Wednesday group were higher than those in the same group before treatment, and the order of control group, Kuntai group and Chinese medicine group showed a decreasing trend, and the difference was statistically significant (p0. 05). 2. In the control group, a series of menopausal symptoms appeared during the treatment period, and the corresponding symptoms in the Kun Tai group and the traditional Chinese medicine group were decreased, and the severity of the menopausal symptoms in the Chinese medicine group was significantly less than that in the Kuntai group. Conclusion: Zishen Ningxin decoction can effectively relieve the menopausal symptoms caused by gonadotropin releasing hormone agonist (GnRH-a) in patients with endometriosis after operation, and the curative effect is better than Kuntai capsule.
【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】：2016
【分類號(hào)】：R271.116

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