温针灸治疗体外受精-胚胎移植中宫腔积液临床疗效观察

Clinical observation on the therapeutic effect of warm acupuncture on endometrial cavity fluid from in vitro fertilization-embryo transfer

目的:观察温针灸治疗体外受精-胚胎移植(IVF-ET)中宫腔积液的临床疗效,探讨温针灸治疗宫腔积液的作用机制。方法:选取2016年至2019年准备行IVF-ET,经阴道B超检查发现宫腔积液而取消移植的患者29例,按随机数字表法分为观察组(14例)和对照组(15例)。观察组在患者月经结束后开始进行温针灸治疗,穴取中脘、气海、关元、中极、归来、子宫、足三里、三阴交,治疗持续60 min,每日1次,5次为一疗程,疗程间休息2 d,连续治疗3个疗程,直至进入IVF助孕周期行胚胎移植;对照组在月经结束后服用鲜益母草胶囊,每日3次,每次0.8 g,7 d为一疗程,连续治疗3个疗程,直至进入IVF助孕周期行胚胎移植。观察治疗前,治疗1、2、3个疗程后两组患者宫腔积液量变化情况、进入IVF助孕周期准备行胚胎移植所需时间及胚胎移植临床结局。结果:观察组宫腔积液减少均较对照组显著(P<0.05);观察组进入IVF助孕周期准备行胚胎移植所需时间较对照组短(P<0.05);观察组的临床妊娠率为42.9%(6/14),明显高于对照组的26.7%(4/15,P<0.05)。结论:温针灸可能是通过提升下腹部局部温度,加速子宫及附件周围血液循环,促进宫腔积液吸收,改善宫腔环境及内膜容受性能,从而提高临床妊娠率。

Objective To observe the clinical effect of warm acupuncture on endometrial cavity fluid(ECF)from in vitro fertilization-embryo transfer(IVF-ET), and to explore the mechanism of warm acupuncture on ECF.Methods Twenty-nine patients who were prepared for IVF-ET from 2016 to 2019 and whose transplantation was cancelled due to ECF found by vaginal B-ultrasound examination were divided into an observation group(14 cases) and a control group(15 cases) according to random number table method. The warm acupuncture was applied at Zhongwan(CV 12),Qihai(CV 6), Guanyuan(CV 4), Zhongji(CV 3), Guilai(ST 29), Zigong(EX-CA 1), Zusanli(ST 36), Sanyinjiao(SP 6) after the end of menstruation in the observation group, the treatment lasted for 60 min, once a day, 5 times as a course, with 2 days interval between the courses and 3 consecutive courses of treatment were given, until the embryo transfer was performed in the IVF assisted pregnancy cycle. After the end of menstruation, fresh leonurus japonicus capsule was given in the control group, 3 times a day, 0.8 g each time, 7 days as a course, and 3 courses of continuous treatment were received, until the embryo transfer was performed in the IVF assisted pregnancy cycle. The changes of ECF before and after treatment, the time required to prepare for embryo transfer during IVF assisted pregnancy cycle, and the clinical outcome of embryo transfer were observed in the two groups. Results The decrease of ECF in the observation group was more significant than that in the control group(P<0.05). The time required for the embryo transfer in the IVF assisted pregnancy cycle in the observation group was shorter than that in the control group(P<0.05). The clinical pregnancy rate in the observation group was 42.9%(6/14), which was significantly higher than 26.7%(4/15) in the control group(P<0.05). Conclusion Warm acupuncture may improve the clinical pregnancy rate by raising the local temperature of the lower abdomen, accelerating the blood circulation around the uterus and appendages, promoting the absorption of ECF, improving the uterine environment and endometrial receptivity.