參芪壽胎湯聯(lián)合地屈孕酮治療先兆流產(chǎn)合并絨毛膜下出血的臨床研究

樊藝 王亞飛

摘 ? 要：目的 ?觀察運(yùn)用自擬方參芪壽胎湯聯(lián)合地屈孕酮治療先兆流產(chǎn)合并絨毛膜下出血的臨床療效。方法 ?選擇我院收治的脾腎兩虛型先兆流產(chǎn)合并絨毛膜下出血患者104例，隨機(jī)分為治療組53例和對(duì)照組51例，對(duì)照組患者口服地屈孕酮治療，治療組在此基礎(chǔ)上口服參芪壽胎湯治療，比較兩組患者陰道出血時(shí)間、停經(jīng)時(shí)間及治療有效率。結(jié)果 ?治療組總有效率為76.92%，高于對(duì)照組的58.82%，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）;治療組患者陰道流血天數(shù)為（9.11±2.83）d，對(duì)照組為（10.55±3.29）d，治療組患者停經(jīng)時(shí)間為（59.72±17.28）d，對(duì)照組為（60.25±17.62）d，組間比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論 ?參芪壽胎湯合并地屈孕酮治療脾腎兩虛型先兆流產(chǎn)合并絨毛膜下出血臨床效果好，可在一定程度改善患者陰道流血情況。

關(guān)鍵詞：先兆流產(chǎn);絨毛膜下出血;地屈孕酮

中圖分類號(hào)：R714.21 ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?文獻(xiàn)標(biāo)識(shí)碼：A ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?DOI：10.3969/j.issn.1006-1959.2018.24.035

文章編號(hào)：1006-1959（2018）24-0123-03

Abstract：Objective ?To observe the clinical efficacy of self-made Shenqi Shoutai Decoction combined with dydrogesterone in the treatment of threatened abortion with subchondral hemorrhage.Methods ?A total of 104 patients with spleen and kidney deficiency and threatened abortion and subchondral hemorrhage were enrolled in our hospital. They were randomly divided into treatment group （n=53） and control group （n=51）. The control group received oral dydrogesterone treatment. On the treatment of oral Shenqi Shoutai Decoction， the vaginal bleeding time， menopause time and treatment efficiency were compared between the two groups.Results ?The total effective rate was 76.92% in the treatment group， which was higher than 58.82% in the control group，the difference was statistically significant （P<0.05）. The vaginal bleeding days in the treatment group were （9.11±2.83） d， and the control group was （10.55±3.29） d， the menopause time of the treatment group was （59.72±17.28） d， and the control group was （60.25±17.62） d，there was no significant difference between the groups （P>0.05）.Conclusion ?Shenqi Shoutai Decoction combined with dydrogesterone in the treatment of spleen and kidney deficiency type threatened abortion combined with submacular hemorrhage has a good clinical effect， which can improve the vaginal bleeding of patients to some extent.

Key words：Threatened abortion;Subchondral hemorrhage;Ddydrogesterone

先兆流產(chǎn)（threatened abortion）患者伴有陰道出血和或腹痛的，超聲提示妊娠囊周圍可見新月形、不規(guī)則形液性暗區(qū)，其致病機(jī)理尚不明確，李清[1]等在對(duì)孕早期絨毛膜下出血和同期先兆流產(chǎn)提示絨毛膜下出血者的妊娠結(jié)局薈萃分析中得出結(jié)論，絨毛膜下出血可增加自然流產(chǎn)的發(fā)生（OR=3.12，95%CI 2.18～4.73）。有研究顯示先兆流產(chǎn)合并絨毛膜下出血易導(dǎo)致患者的不良妊娠結(jié)局，若暗區(qū)長(zhǎng)時(shí)間存在，不能吸收，甚至擴(kuò)大，伴有陰道流血時(shí)間長(zhǎng)，甚至?xí)黾优咄！⒘鳟a(chǎn)的風(fēng)險(xiǎn)。目前臨床上多采用地屈孕酮或黃體酮口服治療，抑制宮縮，合并感染時(shí)，予以抗生素預(yù)防感染治療，因妊娠早中期有妊娠嘔吐反應(yīng)，口服地屈孕酮及或黃體酮治療，會(huì)加重妊娠嘔吐反應(yīng)，且療程較長(zhǎng)，患者癥狀及絨毛膜下出血改善效果不理想。……