胎元饮加减联合依诺肝素钠对气血亏虚型复发性流产诊疗思路

Modified Taiyuanyin(胎元饮)Combined with Enoxaparin Sodium for Recurrent Abortion with Deficiency of Qi and Blood Clinical Thinking

复发性流产是目前妇产科临床常见的生殖疾病,发病率逐年升高,大多发生在怀孕早期,目前该病仍有50%左右发病原因不明,且机制现尚不完全清楚,当前研究表明其与血栓前状态息息相关,对患者及其家庭造成极大的负担和精神心理压力。追寻病史并经中医综合辨证发现本病多数患者存在气血亏虚的病机,不外母体冲任受损或胎元失固,治以益气养血、健脾固冲。血栓前状态导致复发性流产的证据等级为一级,首选抗凝治疗,依诺肝素钠作为常用的一类低分子肝素,分子量小于8 KD,皮下注射吸收好、半衰期长、生物利用度高,保胎作用明确,在妇产科临床使用已超过30年,应用广泛,但其亦存在出血、过敏、引起血小板减少等不良反应,且患者对单纯使用西药依从性较差。胎元饮为张景岳益气养血经典方,配伍得当,具有补气养血、固肾安胎之功效,联合依诺肝素钠治疗气血亏虚型复发性流产,疗效良好,且能有效降低西药不良反应,确保安全。

Recurrent abortion is a common reproductive disease in gynecology and obstetrics.The incidence is increasing year by year.Most of the cases occur in the early stage of pregnancy.At present,the causes of about 50%of the diseases are still unknown.The current research indicates that it is closely related to the prethrombotic state,bringing great burden and mental stress to patients and their families.After tracing the history and syndrome differentiation of traditional Chinese medicine,it is found that most of the patients have Qi and blood deficiency,either Chong and Ren damaged or the fetal Yuan being not solid.The treatment is to replenish Qi,nourish blood and strengthen spleen.The evidence level of recurrent abortion caused by prethrombotic state is grade I,and anticoagulant therapy is the first choice.Enoxaparin sodium,as a kind of commonly-used low molecular weight heparin,has good absorption,long half-life,high bioavailability,and clear fetal protection effect.It has been widely used in obstetrics and gynecology for more than 30 years,but it also has the problems of bleeding,allergy and so on.It can cause adverse reactions such as thrombocytopenia,and the compliance of patients with simple use of Western medicine is poor.Taiyuanyin(胎元饮)is ZHANG Jingyue′s classical prescription of replenishing Qi and nourishing blood.It has the effect of tonifying Qi and nourishing blood,strengthening kidney and stabilizing fetus.Combined with enoxaparin sodium,it has good curative effect in the treatment of recurrent abortion with deficiency of Qi and blood,and can effectively reduce the adverse reactions of Western medicine and ensure safety.