芪断固崩汤加减治疗肾虚血瘀型功能失调性子宫出血临床研究

Clinical Study of Dysfunctional Uterine Bleeding of Kidney Deficiency and Blood Stasis Type Treated with Modified Qiduan Gubeng Decoction(芪断固崩汤加减)

目的分析芪断固崩汤加减治疗肾虚血瘀型功能失调性子宫出血(dysfunctional uterine bleeding,DUB)的临床价值。方法选取三门峡市中心医院中医妇科2018年3月—2021年3月收治的94例肾虚血瘀型DUB患者,随机分为研究组、对照组,各47例,均给予屈螺酮炔雌醇片(Ⅱ)治疗,研究组加用芪断固崩汤,21 d为1个疗程,持续治疗3个疗程。对比两组治疗效果、不良反应,以及中医证候积分、子宫内膜厚度、月经失血图评分等指标变化,分析两种治疗方案的临床疗效与安全性。结果治疗3个疗程后,研究组总有效率为93.62%(44/47),高于对照组的76.60%(36/47),差异有统计学意义(P<0.05)。研究组、对照组治疗期间不良反应发生率分别为6.38%(3/47)、4.26%(2/47),组间比较差异无统计学意义(P>0.05)。两组患者治疗3个疗程后中医证候积分、月经失血图评分均较治疗前下降,研究组治疗3个疗程后中医证候积分、月经失血图评分均较治疗前下降,差异有统计学意义(P<0.05)。两组患者治疗3个疗程后子宫内膜厚度、凝血酶原时间较治疗前下降,D-二聚体较治疗前升高,研究组治疗3个疗程后子宫内膜厚度、凝血酶原时间低于对照组,其D-二聚体高于后者,差异有统计学意义(P<0.05)。结论在孕雌激素药物的基础上联合芪断固崩汤加减治疗肾虚血瘀型DUB疗效确切、安全可靠,有助于患者临床症状与凝血功能的改善。

Objective To analyze the clinical value of Modified Qiduan Gubeng Decoction(芪断固崩汤加减)in the treatment of dysfunctional uterine bleeding(DUB)of kidney deficiency and blood stasis type.Methods A total of 94 patients with DUB due to kidney deficiency and blood stasis who were admitted to the TCM Gynaecology Department of Sanmenxia Central Hospital from March 2018 to March 2021 were randomly divided into a study group and a control group,47 cases in each one.They were all treated with Spironoethinyl Estradiol Tablets(II).The study group was additionally treated with Modified Qiduan Gubeng Decoction,with 21 d as a course of treatment and continuous treatment for 3 courses.The therapeutic effects and adverse reactions as well as the changes of TCM syndrome score,endometrial thickness and menstrual blood loss map score were compared between the two groups,and the clinical efficacy and safety of the two treatment options were analyzed.Results After three courses of treatment,the total effective rate of the study group was 93.62%(44/47),which was higher than 76.60%(36/47)of the control group and the difference was statistically significant(P<0.05).The incidence rates of adverse reactions in the study group and the control group during the treatment were 6.38%(3/47)and 4.26%(2/47),respectively,and there was no significant difference between the two groups(P>0.05).After three courses of treatment,the TCM syndrome score and the menstrual blood loss map score in both groups were decreased compared with those before treatment.However,the TCM syndrome score and the menstrual blood loss map score in the study group after three courses of treatment were decreased compared with those before treatment,and the differences were statistically significant(P<0.05).After three courses of treatment,the endometrial thickness and prothrombin time were decreased in both groups,while the D-dimer was increased in both groups.After three courses of treatment,the endometrial thickness and prothrombin time in the study group were lower than those in the control group,and the D-dimer was higher,showing a statistically significant difference(P<0.05).Conclusion The combination of pregnant estrogen drugs and Modified Qiduan Gubeng Decoction has reliable and safe effects on DUB due to kidney deficiency and blood stasis,which is helpful to improve the clinical symptoms and coagulation function of patients.