加味脱花煎在早期妊娠药物流产中的临床疗效观察

Observation of the clinical efficacy of Modified Tuohua Decoction in the treatment of medical abortion for early pregnancy

目的观察加味脱花煎联合米非司酮及米索前列醇在早期妊娠药物流产中的临床疗效。方法选取2017年7月至2019年7月我院妇产科门诊选择药物流产的早期计划外妊娠者共600例。根据随机数字表法分为观察组和对照组,每组300例。对照组给予米非司酮联合米索前列醇,观察组在对照组基础上加服加味脱花煎,观察两组的完全流产率、孕囊排出时间、阴道流血时间、宫内残留组织及不良反应发生情况。结果观察组完全流产率(98.3%)显著高于对照组(93.7%);观察组孕囊排出时间(中位数3 h)明显少于对照组(中位数5 h)(P<0.05);观察组流产后阴道流血时间(中位数6 d)明显短于对照组(中位数11 d)(P<0.05);流产后15 d复查彩超,宫内组织残留明显少于对照组(P<0.05);不良反应发生率无明显统计学差异(P>0.05)。结论加味脱花煎用于早期妊娠药物流产,能促进孕囊排出,利于妊娠滋养细胞的凋亡,减少阴道流血和胚物残留,促进子宫复旧,从而减少了再次清宫及流产后感染的风险,值得临床推广。

Objective To observe the clinical efficacy of Modified Tuohua Decoction combined with Mifepristone and Misoprostol in the treatment of medical abortion for early pregnancy.Methods 600 cases of early pregnancy with medial abortion from July 2017 to July 2019 were recruited in this study.According to the random number table method,it was divided into observation group and control group,300 cases in each group.In the control group,Mifepristone and Misoprostol were given for abortion,while in the observation group,Modified Tuohua Decoction was used for abortion more than the control group.The rate of abortion,the discharge time of gestational sac,the time of vaginal bleeding,the remnant of pregnancy sac tissue in the uterus and adverse reactions were compared in two groups.Results The total abortion rate of the observation group(98.3%)was significantly higher than that of the control group(93.7%);The discharge time of pregnancy sac in the observation group(median 3 h)was significantly less than that in the control group(median 5 h)(P<0.05);The time of vaginal bleeding after abortion in the observation group(median 6 days)was significantly shorter than that in the control group(median 11 days)(P<0.05);At the time of color doppler ultrasound review 15 days after abortion,intrauterine tissue residue in the observation group was significantly less than that in the control group(P<0.05);There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Modified Tuohua Decoction is used in the treatment of medical abortion for early pregnancy,which can promote the expulsion of pregnancy sac,facilitate the apoptosis of pregnancy trophoblast cells,reduce vaginal bleeding and embryo residue,and promote uterine rejuvenation.Thus the risk of second palace clearing and the infection after abortion can be reduced,which is worthy of clinical promotion.