中西医综合治疗子宫肌瘤合并复发性流产临床观察

Clinical observation on hysteromyoma combined with recurrent abortion treated with integrated traditional Chinese and western medicine

目的探讨中西药综合治疗子宫肌瘤合并复发性流产临床效果及对患者妊娠结局的影响。方法选择2020-01-01-2022-01-31济宁医学院附属医院(50例)和济宁市中医院(16例)诊断明确并配合治疗的子宫肌瘤合并复发性流产患者66例,根据组间基本资料均衡可比的原则分为观察组与对照组,每组33例。对照组患者孕前常规口服米非司酮片12.5 mg/d,连用3个月,妊娠第4~16周给予地屈孕酮片口服10 mg,2次/d,强的松口服5~10 mg,1次/d,维生素E软胶囊口服100 mg,1次/d,同时皮下注射低分子肝素钙5000 Axa,1次/d;观察组患者在对照组治疗的基础上进行中医治疗,即未孕前加服中药化积汤加减治疗,水煎400 mL,分早晚饭后0.5 h温服,每日1剂,调理5个月经周期,妊娠后改用安胎防漏益气方,每日1剂,水煎服,分早晚2次,于饭后0.5 h温服。比较2组患者治疗前后临床疗效以及妊娠结局指标。结果治疗后,观察组痊愈15例,显效13例,有效3例,无效2例,总有效率为93.94%,对照组痊愈8例,显效9例,有效8例,无效8例,总有效率为75.76%,2组差异有统计学意义,χ^(2)=8.730,P=0.033。治疗前,2组患者子宫肌瘤体积、月经量比较,差异无统计学意义,均P>0.05;治疗后,观察组子宫肌瘤体积为(29.36±3.80)cm^(3),小于对照组的(41.06±3.92)cm^(3),差异有统计学意义,t=6.945,P<0.001;观察组月经量为(191.49±10.12)mL,低于对照组的(236.33±10.23)mL,差异有统计学意义,t=8.731,P<0.001。观察组患者保胎成功率为84.85%,明显高于对照组的69.70%,差异有统计学意义,χ^(2)=3.882,P=0.048。结论中西医综合治疗子宫肌瘤合并复发性流产临床效果显著,且能有效改善患者的妊娠结局。

Objective To explore the clinical effect of Chinese and western medicine on hysteromyoma complicated with recurrent abortion and its influence on pregnancy outcome.Methods From January 1,2020to January 1,2022to January31,2020,66patients with hysteromyoma complicated with recurrent abortion diagnosed and treated in the Affiliated Hospital of Jining Medical College(50cases)and Jining Hospital of Traditional Chinese Medicine(16cases)were selected.According to the principle of balanced and comparable basic data between groups,they were divided into observation group and control group,with 33cases in each group.The patients in the control group took mifepristone tablets 12.5mg/d orally before pregnancy for 3months.At the 4th to 16th weeks of pregnancy,they were given didroxyprogesterone tablets 10mg orally,twice a day,prednisone tablets 5to 10mg orally,once a day,vitamin E soft capsules 100mg orally,once a day,and low molecular weight heparin calcium 5000Axa subcutaneously,once a day.The patients in the observation group were treated with traditional Chinese medicine on the basis of the treatment in the control group,that was,before pregnancy,they were treated with the addition and subtraction of Huaji decoction,boiled with 400 ml of water,warm taken 0.5hours after breakfast and dinner,one dose a day,and conditioned for 5menstrual cycles.After pregnancy,they were changed to Antai fanglouyiqi recipe,one dose a day,boiled with water,twice in the morning and evening,and warm taken 0.5hours after meals.The clinical efficacy and pregnancy outcome indexes of the two groups were compared before and after treatment.Results After treatment,15cases in the observation group were cured,13cases were significantly effective,3cases were effective,2cases were ineffective,and the total effective rate was 93.94%.In the control group,8cases were cured,9cases were significantly effective,8cases were effective,8cases were ineffective,and the total effective rate was 75.76%.The difference between the two groups was statistically significant,χ^(2)=8.730,P=0.033.Before treatment,there was no significant difference in uterine fibroid volume and menstrual volume between the two groups(P>0.05).After treatment,the volume of hysteromyoma in the observation group was(29.36±3.80)cm^(3),which was smaller than that in the control group(41.06±3.92)cm^(3),the difference was statistically significant,t=6.945,P<0.001.The menstrual volume of the observation group was(191.49±10.12)ml,lower than that of the control group(236.33±10.23)ml,the difference was statistically significant,t=8.731,P<0.001.The success rate of fetal protection in the observation group was 84.85%,significantly higher than 69.70%in the control group,and the difference was statistically significant,χ^(2)=3.882,P=0.048.Conclusion The comprehensive treatment of hysteromyoma combined with recurrent abortion with traditional Chinese and Western medicine has a significant clinical effect,and can effectively improve the pregnancy outcome of patients.