高原与零海拔区域复发性流产中西医结合治疗效果观察

Observation on the Curative Effect of Combined Traditional Chinese and Western Medicine on Recurrent Spontaneous Abortion in Plateau and Zero Altitude Area

目的:观察高原与零海拔区域血栓前状态(PTS)所致复发性流产(RSA)运用中西医结合治疗的疗效。方法:选取2017年1月至2018年8月于广州中医药大学深圳医院(福田)门诊及住院的RSA妇女73例,随机将其分为零海拔观察组38例和零海拔对照组35例。同期选取新疆塔什库尔干县人民医院门诊及住院的RSA妇女64例,随机将其分为高原观察组33例和高原对照组31例,所有对照组均采用阿司匹林抗凝治疗,所有观察组均加用桂枝茯苓丸加减治疗。观察两区域治疗前后各组凝血四项〔凝血酶原时间(PT)、部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fbg)〕、血小板(PLT)、血细胞比容(HCT)的变化及妊娠结局。结果:零海拔观察组总有效率高于零海拔对照组,高原观察组的总有效率高于高原对照组,差异具有统计学意义(P <0.05);零海拔对照组、零海拔观察组、高原对照组组内治疗前后相比,Fbg、HCT显著降低,TT、PT显著升高,差异均具有统计学意义(P <0.05)(零海拔观察组为P <0.01),APTT、PLT稍上升,但差异无统计学意义(P> 0.05);高原观察组治疗前后相比,Fbg、HCT显著降低,APTT、TT、PT显著升高,差异均具有统计学意义(P <0.01),PLT稍上升,但差异无统计学意义(P> 0.05);零海拔观察组(高原观察组)的治疗后的Fbg、TT、PT及HCT均较零海拔对照组(高原对照组)改善更多,差异均具有统计学意义(P <0.05);零海拔区域保胎成功52例,足月分娩17例;高原区域保胎成功47例,足月分娩16例。结论:对于RSA患者在西医抗凝治疗同时,辨证运用桂枝茯苓丸加减活血化瘀,可以更好地改善妊娠期血液高凝状态,提高保胎成功率,安全可靠,尤其对改善高原地区妇女生育状态具有更重要的社会意义。

Objective To observe the efficacy of recurrent spontaneous abortion(RSA) in patients with prethromboticstate(PTS) at plateau and zero altitude. Methods 73 RSA women were enrolled in the outpatient clinic and hospitalized from Guangzhou University of Traditional Chinese Medicine Shenzhen(Futian) from January 2017 to August 2018. They were randomly divided into zero elevation observation group of 38 cases and zero elevation control group of 35 cases. In the same period, 64 women with RSA were selected from the outpatient department and hospitalized in the people’s hospital of Tashkurgan County, Xinjiang.They were randomly divided into a plateau observation group of 33 cases and a plateau control group of 31 cases.The control group was treated with aspirin anticoagulant therapy, and the treatment group was treated with Guizhifuling pills. Observe two area each groups before and after treatment the change of Prothrombin time(PT), Activated partial thrombin time( APTT), thrombin time(TT),Fibrinogen(Fbg), platelet(PLT), Hematocrit(HCT), and the pregnancy outcomes. Results The total effective rate of the zeroaltitude observation group was higher than that of the zero-altitude control group. The total effective rate of the plateau observation group was higher than that of the plateau control group, and the difference was statistically significant(P < 0.05). Compared with before and after treatment in the zero-altitude control group, the zero-altitude observation group, and the high-altitude control group,the Fbg and HCT were significantly decreased, and the TT and PT were significantly increased, the difference was statistically significant(P < 0.05).while zero elevation group is P < 0.01, APTT, PLT increased slightly, but the difference was not statistically significant(P > 0.05);Compared with before and after treatment, Fbg and HCT were significantly decreased, APTT, TT and PT were significantly increased, the difference was statistically significant(P < 0.01), PLT increased slightly, but the difference was not statistically significant(P > 0.05);The Fbg, TT, PT and HCT of the zero-altitude observation group(plateau observation group) were more improved than the zero-altitude control group(plateau control group), and the difference was statistically significant(P < 0.05).In the zero-altitude area, there were 52 cases of successful fetus, 17 cases of full-term delivery, 47 cases of high-level birth insurance,and 16 cases of full-term delivery. Conclusion For RSA patients in western medicine anticoagulant treatment at the same time,the use of guizhi fuling pills dialectical huoxue huayu, can better improve the pregnancy blood hypercoagulation state, improve the success rate of fetal protection, safe and reliable, worthy of promotion, especially to improve the plateau area of women’s reproductive status has important social significance.