当归芍药颗粒联合去氧孕烯炔雌醇治疗原发性痛经的临床研究

Clinical study on Danggui Shaoyao Granules combined with desogestrel and ethinylestradiol in treatment of primary dysmenorrhea

目的探讨当归芍药颗粒联合去氧孕烯炔雌醇治疗原发性痛经的临床效果。方法选取2017年2月-2019年2月青海红十字医院收治的128例原发性痛经患者,随机分为对照组和治疗组,每组各64例。对照组患者口服去氧孕烯炔雌醇片,1片/次,1次/d,具体为于月经来潮的第1 d开始服药,连服21 d,继而停药7 d,即以28 d为1个治疗周期。治疗组在对照组基础上口服当归芍药颗粒,1袋/次,3次/d,温开水送服,具体是在月经前3 d开始服药,连服10 d,随后停药18 d,即1个治疗周期的时间同上。两组均连续治疗3个周期。观察两组的临床疗效,比较两组治疗前后VAS评分、痛经持续时间、CMSS评分、双侧子宫动脉血流动力学指标的变化情况。结果治疗后,对照组和治疗组的总有效率分别是84.4%、95.5%,两组比较差异具有统计学意义(P<0.05)。治疗后,两组痛经疼痛VAS评分及CMSS中痛经症状严重程度评分、持续时间评分较治疗前均显著降低,而痛经持续时间则均显著缩短,同组治疗前后比较差异有统计学意义(P<0.05);治疗后,治疗组VAS评分及CMSS中痛经症状严重程度评分、持续时间评分显著低于对照组,而痛经持续时间显著短于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组双侧子宫动脉收缩期S波、舒张期D波峰值流速比值(S/D)、搏动指数(PI)及阻力指数(RI)值均显著低于治疗前,同组治疗前后比较差异有统计学意义(P<0.05);治疗后,治疗组这些子宫动脉血流动力学参数显著低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组血浆前列腺素F2α(PGF2α)、白介素-10(IL-10)水平均显著下降,同组治疗前后比较差异有统计学意义(P<0.05);治疗后,治疗组PGF2α、IL-10水平显著低于对照组,两组比较差异具有统计学意义(P<0.05)。结论当归芍药颗粒联合去氧孕烯炔雌醇治疗原发性痛经的疗效确切,能有效改善患者痛经症状的严重程度和持续时间,减少致痛介质释放,改善子宫动脉的高阻低速血流状态,具有一定的临床推广应用价值。

Objective To investigate the clinical effect of Danggui Shaoyao Granules combined with desogestrel ethinylestradiol in treatment of primary dysmenorrhea. Methods 128 Patients with primary dysmenorrhea in Qinghai Red Cross Hospital from February 2017 to February 2019 were randomly divided into control(n=64) and treatment group(n=64). Patients in the control group were po administered with Desogestrel and Ethinylestradiol Tablets, 1 tablet/time, once daily. Specifically, the drug was started on the first day of menstruation, continued for 21 d, and then stopped for 7 d, and 28 d was for one treatment cycle. Patients in the treatment group were po administered with Danggui Shaoyao Granules on the basis of the control group, 1 bag/time, three times daily. Specifically, the drug was started 3 d before menstruation, continued for 10 d, and then stopped for 18 d, and the treatment cycle was the same as above. The two groups received 3 cycles of treatment. After treatment, the clinical efficacy was evaluated, and the changes of VAS score, dysmenorrhea duration, CMSS score, and hemodynamic indicators of bilateral uterine artery in two groups were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 84.4% and 95.5%, respectively, and there were differences between two groups(P < 0.05). After treatment, VAS score of dysmenorrhea, severity score and duration score of dysmenorrhea in CMSS in two groups were significantly decreased, but dysmenorrhea duration was significantly shortened, and there were differences in the same group(P < 0.05). After treatment, VAS score of dysmenorrhea, severity score and duration score of dysmenorrhea in CMSS in the treatment group were significantly lower than those in the control group, dysmenorrhea duration was significantly shorter than that in the control group, and there were differences between two groups(P < 0.05). After treatment, bilateral uterine artery systole S wave, diastole D wave peak velocity ratio(S/D), pulse index(PI) and resistance index(RI) in two groups were significantly decreased, and there were differences in the same group(P < 0.05). After treatment, these uterine arterial hemodynamic parameters were lower than those in the control group, and there were differences between two groups(P < 0.05). After treatment, PGF2α and IL-10 in two groups were significantly decreased, and there were differences in the same group(P < 0.05). After treatment, PGF2α and IL-10 were lower than those in the control group, and there were differences between two groups(P < 0.05). Conclusion Danggui Shaoyao Granules combined with desogestrel and ethinylestradiol has significant effect in treatment of primary dysmenorrheal, and can effectively improve the severity and duration of dyspenorrhea symptoms in patients, and can reduce the release of pain-causing mediators, and improve the state of high resistance and low blood flow in uterine arteries, which has a certain clinical application value.