不明原因复发性流产中西医治疗的研究进展

Research advances of Chinese and Western medicine in the treatment of unexplained recurrent spontaneous abortion

复发性流产是临床妇科常见病,严重影响着女性生殖健康,给社会及家庭带来沉重负担及痛苦。复发性流产的病因较为复杂,除已明确的遗传、解剖、感染及内分泌等因素外,尚有部分原因不明,称之为不明原因复发性流产,约占复发性流产的40%。目前,临床上已有大量研究对不明原因复发性流产患者的治疗方法进行探索,研究显示中西医治疗均具有一定的临床应用效果。西医临床主要包括免疫治疗、免疫抑制治疗、抗凝治疗、孕激素治疗等。总结导师经验的基础并结合多年临床实践,笔者以为本病中医病机主要在冲任受损,脾气虚弱,气血亏虚,不能摄精成孕以养胎;肾气不足,血行迟滞,血瘀胞脉无以养胎。临证以补肾健脾养血,活血化瘀通络为基本治则,口服中药配合针灸外治,提高妊娠率。本文对国内外治疗不明原因复发性流产的方法进行综述,以期为临床提供参考。

Recurrent spontaneous abortion is a common disease in gynecology,and it seriously affects women’s reproductive health and brings heavy burden and pain to society and families. The cause of recurrent spontaneous abortion is complicated,in addition to the well-defined genetic,anatomical,infection and endocrine factors,and there are still some unknown causes,which is called as unexplained recurrent spontaneous abortion,accounting for 40% of recurrent abortion. At present,there are a lot of researches on the treatment methods of the patients with the unexplained recurrent spontaneous abortion,which also shows that the treatments of traditional Chinese and Western medicine all have certain clinical application effect. Western medicine clinical methods mainly include immunotherapy,immunosuppressive therapy,anticoagulation therapy,progesterone therapy,etc. Based on the experience of our professor and combined with many years of clinical practice,the author believes that the pathogenesis of this disease in traditional Chinese medicine is mainly due to impaired impulse and deficiency of spleen,lack of Qi and blood,which cannot nourish the fetus;deficiency of kidney Qi,delayed blood flow,and blood stasis which could not raise the fetus. Clinical treatment is based on invigorating the kidney,tonifying spleen and nourishing blood,promoting blood circulation to remove blood stasis and dredge collaterals. Oral Chinese medicine combined with external acupuncture and moxibustion has achieved excellent effects in im-proving pregnancy rate. This article reviews the domestic and foreign methods of treating unexplained recurrent miscarriage in order to provide clinical reference. In the future,the combination of Chinese and Western medicine should become the main therapy to increase pregnancy rate.