补肾活血方联合地屈孕酮片治疗先兆流产合并宫腔积血的临床观察

Clinical observation on Bushen Huoxue Decoction combined with dydrogesterone tablet in treating threatened abortion with intrauterine hematocele

目的:探讨补肾活血方联合地屈孕酮片治疗肾虚型先兆流产合并宫腔积血的临床疗效。方法:纳入肾虚型先兆流产合并宫腔积血患者70例,随机分为治疗组(35例)和对照组(35例)。治疗组患者给予补肾活血方联合地屈孕酮片口服治疗,对照组患者给予补肾方联合地屈孕酮片口服治疗,治疗周期均为2周。评价两组患者的临床疗效,比较两组患者的中医证候评分,检测患者的血清D-二聚体水平,B超下测定患者治疗前后的宫腔积血面积及子宫动脉的血流收缩期峰值流速与舒张末期流速之比(S/D)、动脉阻力指数(RI)。结果:①治疗后,治疗组和对照组的临床总有效率分别为85.71%和74.29%,治疗组的临床疗效优于对照组(P<0.05)。②治疗后,两组患者的中医证候总评分及各项主症评分较治疗前均明显降低(P<0.05,P<0.01),且治疗组患者的中医证候总评分及阴道出血、腹痛评分低于对照组(P<0.05)。③治疗前后,两组患者的D-二聚体水平比较,差异均无统计学意义(P>0.05)。④治疗后,两组患者的子宫动脉S/D、RI水平较治疗前均降低(P<0.05),且治疗组患者的RI水平低于对照组(P<0.05)。⑤治疗后,两组患者的宫腔积血面积较治疗前均减小(P<0.01),且治疗组患者的宫腔积血面积小于对照组(P<0.05)。结论:与补肾方联合地屈孕酮片相比,补肾活血方联合地屈孕酮片能够更好地改善先兆流产合并宫腔积血患者的妊娠结局,提高患者的子宫动脉供血,促进宫腔积血的吸收,改善患者的临床症状。

Objective: To explore the clinical efficacy of Bushen Huoxue Decoction combined with dydrogesterone tablet in the treatment of threatened abortion(syndrome of kidney deficiency)with intrauterine hematocele. Methods: A total of 70 patients with threatened abortion(syndrome of kidney deficiency) combined with intrauterine hematocele were selected and randomly divided into the treatment group(35 cases) and the control group(35 cases). The patients in the treatment group were orally treated with Bushen Huoxue Decoction combined with dydrogesterone tablet, and the patients in the control group were orally treated with Bushen Decoction combined with dydrogesterone table, with a course of two weeks.The clinical efficacy of the two groups was evaluated, the Chinese medical syndrome scores of the two groups were compared, the serum level of D-dimer was detected, and the intrauterine hematocele area,the ratio of peak systolic velocity to end diastolic velocity(S/D) and resistance index(RI) of uterine artery were detected by B ultrasound before and after treatment. Results: ①After treatment,the total clinical effective rates of the treatment group and the control group were 85.71% and 74.29% respectively,and the clinical efficacy of the treatment group was better than that of the control group(P<0.05).(2) After treatment,the total score of Chinese medical syndrome and the scores of all major symptoms were obviously decreased in both groups compared with those before treatment(P<0.05,P < 0. 01),and the total score of Chinese medical syndrome and the scores of vaginal bleeding and abdominal pain in the treatment group were lower than those in the control group(P<0.05).(3)Before and after treatment,there was no statistically significant difference on the level of D-dimer between the two groups(P>0.05).(4)After treatment,the S/D ratio and RI of uterine artery were decreased in both groups compared with those before treatment(P<0.05),and the RI level of the treatment group was lower than that of the control group(P<0.05).(5)After treatment,the intrauterine hematocele area was reduced in both groups compared with that before treatment(P<0.01),and the intrauterine hematocele area of the treatment group was less than that of the control group(P<0.05).Conclusion: Compared with Bushen Decoction combined with dydrogesterone tablet,Bushen Huoxue Decoction combined with dydrogesterone tablet can better improve the pregnancy outcome of patients in threatened abortion combined with intrauterine hematocele,enhance the blood supply of uterine artery,promote the absorption of intrauterine hematocele,and improve the clinical symptoms of the patients.