清瘀利胆汤中西医结合治疗ICP的作用及母婴结局

Effect of western therapy combined with qingyulidan decoction on intrahepatic cholestasis of pregnancy and maternal and neonatal outcomes

目的探究清瘀利胆汤中西医结合治疗妊娠期肝内胆汁淤积症的作用及母婴结局。方法选取青海省交通医院在2014年12月至2016年12月期间收治的、符合纳入标准的妊娠期肝内胆汁淤积症孕妇120例,按随机数字表法分为实验组(n=60)和对照组(n=60),实验组行淤利胆西医常规治疗联合清汤,对照组行西医常规治疗。对比两组的肝生化指标、瘙痒程度、临床疗效及母婴结局。结果与对照组相比,实验组经治疗后,其谷丙转氨酶、谷草转氨酶、血清总胆汁酸、瘙痒程度评分、剖宫产率、产后出血、新生儿窒息、早产、宫内窘迫均处于较低水平,差异具有统计学意义(t/χ~2值分别为16.63、19.22、14.94、6.67、24.51、4.89、15.42、13.82、17.02,均P<0.05);实验组的给药后分娩孕周延后(t=26.34,P<0.01);治疗后,实验组与对照组的临床有效率分别为93.33%(56/60)、70.00%(42/60),差异具有统计学意义(χ~2=18.18,P<0.01)。结论西医常规治疗联合清瘀利胆汤能够有效改善妊娠期肝内胆汁淤积症孕妇肝生化指标,降低瘙痒程度,提高母婴结局。

Objective To explore the effect of western therapy combined with qingyulidan decoction on intrahepatic cholestasis of pregnancy（ ICP） and maternal and neonatal outcomes. Methods Totally 120 cases of ICP admitted in Qinghai Traffic Hospital from December 2014 to December 2016 were collected,and they were divided into experimental group（ n = 60） and control group（ n = 60） according to random number table method. The control group was given conventional therapy,and the experimental group received conventional therapy combined with qingyulidan decoction treatment. Liver biochemical indexes,degree of pruritus,clinical efficacy as well as maternal and neonatal outcomes in two groups were compared. Results After treatment,glutamic-pyruvic transaminase level,glutamic-oxalacetic transaminase level,serum total bile acid level,pruritus score,cesarean section rate,incidence of postpartum hemorrhage,neonatal asphyxia,premature birth and fetal distress in the experimental group were lower than those in the control group（ t/χ^2value was 16. 63,19. 22,14. 94,6. 67,24. 51,4. 89,15. 42,13. 82 and 17. 02,respectively,all P〈 0. 05）. After treatment,the gestational weeks of the experimental group was longer（ t = 26. 34,P〈 0. 01）. After treatment,clinical efficacy of the experimental group and the control group was 93. 33%（ 56/60） and 70. 00%（ 49/60）,respectively,and the difference was statistically significant（ χ^2= 18. 18,P 0. 01）.Conclusion Conventional therapy combined with qingyulidan decoction can effectively improve the liver biochemical indexes of patients with ICP. It can reduce the degree of pruritus and improve maternal and neonatal outcomes.