五加生化胶囊结合甲氨蝶呤治疗植入性胎盘临床疗效及安全性观察

Clinical Efficacy and Safety of Wujia Shenghua Capsule(五加生化胶囊)Combined with Methotrexate in Treatment of Implanted Placenta

目的探究五加生化胶囊结合甲氨蝶呤治疗植入性胎盘临床疗效及安全性。方法研究合计纳入83例植入性胎盘患者,均由医院2018年6月—2020年3月收治,采取随机数字表法将患者分为对照组以及观察组,予以对照组患者(41例)甲氨蝶呤治疗,予以观察组患者(42例)五加生化胶囊结合甲氨蝶呤治疗,比较各组患者治疗效果、治疗前后患者胎盘植入组织最大直径变化、治疗前后患者中医症状(产后持续流血、小腹坠痛、腰酸、舌黯红瘀点、苔薄白、脉涩或细数)积分变化、治疗前后患者子宫内膜厚度变化、治疗后各组患者出血持续时间及胎盘排除时间、血绒毛膜促性腺激素恢复正常时间(HCG)、患者治疗后盆腔炎症发生率、继发性不孕发生率、不良反应情况。结果观察组患者治疗效果优于对照组患者,P<0.05;治疗前两组患者胎盘植入组织最大直径比较,P>0.05,治疗后各组患者胎盘植入组织最大直径均缩小,观察组患者治疗后胎盘植入组织最大直径小于对照组,P<0.05;治疗前,两组患者产后持续流血、小腹坠痛、腰酸、舌黯红瘀点、苔薄白、脉涩或细数等中医症状积分比较,P>0.05,治疗后各组患者产后持续流血、小腹坠痛、腰酸、舌黯红瘀点、苔薄白、脉涩或细数等中医症状降低,观察组患者治疗后产后持续流血、小腹坠痛、腰酸、舌黯红瘀点、苔薄白、脉涩或细数低于对照组患者,P<0.05;治疗后,观察组患者子宫内膜厚度情况显著优于对照组,P<0.05;观察组患者出血持续时间及胎盘排除时间、血绒毛膜促性腺激素恢复正常时间均短于对照组患者,P<0.05;观察组患者盆腔炎症发生率(4.76%,2/42)低于对照组(21.95%,9/41),继发性不孕发生率(0.00%)低于对照组(9.76%,4/41)(P<0.05);观察组患者不良反应(4.76%,2/42)与对照组不良反应率(7.32%,3/41)均较低,P>0.05。结论五加生化胶囊结合甲氨蝶呤治疗植入性胎盘临床疗效显著,盆腔炎症发生率、继发性不孕发生率降低,患者恢复较好,不良反应率低,安全可靠,值得应用。

Objective To explore the clinical efficacy and safety of Wujia Shenghua Capsule(五加生化胶囊) combined with methotrexate in the treatment of implanted placenta. Methods A total of 83 patients with implantable placenta were included in this study, all of whom were admitted to our hospital from June 2018 to March 2020. Patients were divided into the control group and the observation group by the random number table method. Patients in the control group(41 cases) were treated with methotrexate, and those in the observation group(42 cases) were treated with Wujia Shenghua Capsule combined with methotrexate. The treatment effect, the maximal diameter of placenta accreta, the integral changes of TCM symptoms(postpartum continuous bleeding, abdominal pain, back pain, dark red tongue and petechiae, thin white fur, unsmooth pulse or thread and rapid pulse), the endometrial thickness, bleeding duration and placenta elimination time were compared before and after treatment. The recovery time of HCG, the incidence of pelvic inflammation after treatment, the incidence of secondary infertility and adverse reactions were analyzed. Results The treatment effect of the observation group was better than that of the control group(P<0.05). The maximal diameter of placental implant tissue between the two groups before treatment showed no difference(P>0.05) and the maximal diameter of placental implant tissue in each group was decreased after treatment. The maximal diameter of placental implant tissue in the observation group was smaller than that in the control group(P<0.05). Before treatment, two groups’ integral changes of TCM symptoms(postpartum continuous bleeding, abdominal pain, back pain, dark red tongue and petechiae, thin white fur, unsmooth pulse or thread and rapid pulse) had no difference(P>0.05). After treatment, TCM symptoms integral of the observation group was lower than that of the control group(P<0.05). After treatment, the endometrial thickness in the observation group was significantly better than that in the control group(P<0.05). The duration of bleeding, elimination time of placenta and recovery time of chorionic gonadotropin in the observation group were shorter than those in the control group(P<0.05). The incidence of pelvic inflammation(4.76%,2/42) in the observation group was lower than that(21.95%,9/41) in the control group, and the incidence of secondary infertility(0.00%) was lower than that(9.76%,4/41) of the control group(P<0.05). The rates of adverse reactions in the observation group(4.76%,2/42) and the control group(7.32%,3/41) were lower(P>0.05). Conclusion Wujia Shenghua Capsule combined with methotrexate in the treatment of implanted placenta has a significant clinical effect. The incidence of pelvic inflammation and secondary infertility has been reduced. The recovery is better and the rate of adverse reactions is low. It is safe and reliable, and worthy of application.