脱花煎加减配合米索前列醇治疗不完全流产的效果

Effect of Modified Tuohua Decoction(脱花煎)with Miepristone in Treatment of Incomplete Abortion

目的探讨脱花煎加减配合米索前列醇治疗不完全流产的效果。方法选取2019年1月—2021年10月医院收治的不完全流产患者96例,随机分为研究组(56例)和对照组(40例)两组,给予对照组米索前列醇治疗,研究组在米索前列醇治疗基础上,加用脱花煎。观察对比两组患者疗效,阴道停止流血时间,月经复潮时间,子宫内膜厚度,尿人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)变化情况,性激素情况,不良反应发生情况,患者焦虑心理以及生活质量情况。结果治疗后,研究组显效44例(78.57%),有效9例(16.07%),无效3例(5.36%),对照组显效24例(60.00%),有效4例(10.00%),无效12例(30.00%),研究组总有效率94.64%高于对照组70.00%(P<0.05)。治疗后,研究组阴道停止流血时间(1.29±1.03)d短于对照组(1.79±1.27)d(P<0.05),月经复潮时间(31.35±2.19)d也短于对照组(37.79±2.68)d(P<0.05),子宫内膜厚度(6.09±1.10)mm较对照组(5.14±0.81)mm更厚(P<0.05),研究组尿hCG改善52例,对照组改善33例,研究组改善率92.6%高于对照组82.50%,但差异无统计学意义(P>0.05)研究组与对照组性激素促卵泡激素(follicle stimulating hormone,FSH)分别为(6.42±1.93)IU/L、(6.08±1.48)IU/L,促黄体生成素(luteinizing hormone,LH)分别为(4.59±1.86)IU/L、(5.31±1.80)IU/L,雌二醇(Estradiol,E2)分别为(144.48±42.10)pmol/L、(159.59±53.19)pmol/L,指标差异均无统计学意义(P>0.05)。治疗前研究组焦虑评分(57.49±6.78)分与对照组(57.49±6.78)分、生活质量评分(69.49±4.78)分与对照组(70.03±4.57)分均差异无统计学意义(P>0.05);治疗后,两组焦虑评分均明显降低,且研究组(37.48±4.36)分低于对照组(44.65±4.69)分(P<0.05)。两组生活质量评分均明显升高(P<0.05),且研究组(89.45±7.26)分高于对照组(82.39±11.46)分(P<0.05)。经过2个月的随访了解到,研究组出现1例(1.79%)宫腔感染病例,1例(1.79%)月经不调病例,对照组出现3例(7.50%)宫腔感染,1例(2.50%)宫腔粘连,4例(10.00%)月经不调,研究组不良反应发生率3.57%明显低于对照组20.00%(P<0.05)。结论脱花煎加减配合米索前列醇治疗不完全流产,能够显著改善治疗效果,缩短患者阴道流血时间和月经复潮时间,促进子宫内膜修复,加速子宫功能恢复,同时减少不良反应的发生,改善生活质量,减轻生理和心理负担。

Objective To investigate the effect of Modified Tuohua Decoction(脱花煎)combined with misoprostol on incom⁃plete abortion.Methods Ninety-six patients with incomplete abortion in the hospital from January 2019 to October 2021 were enrolled and randomly divided into two groups.The control group(40 cases)received misoprostol,while the study group(56 ca⁃ses)received misoprostol combined with Modified Tuohua Decoction.Then the clinical efficacy,vaginal bleeding cessation time,menstrual recovery time,endometrial thickness,changes of urinary human chorionic gonadotropin(HCG),sex hormone indexes,adverse reaction rate,anxiety level and quality of life were compared between the two groups.Results After treatment,44 cases(78.57%)were significantly effective,9 cases(16.07%)were effective and 3 cases(5.36%)were ineffective in the study group,while 24 cases(60.00%)were significantly effective,4 cases(10.00%)were effective and 12 cases(30.00%)were in⁃effective in the control group.The total effective rate was 94.64%in the study group,which was significantly higher than 70.00%in the control group(P<0.05).The vaginal bleeding cessation time and menstrual recovery time were(1.29±1.03)d and(31.35±2.19)d in the study group,which were significantly shorter than(1.79±1.27)d and(37.79±2.68)d in the control group with statistical difference(P<0.05).The endometrial thickness was(6.09±1.10)mm in the study group,which were significantly thicker than(5.14±0.81)mm in the control group with statistical difference(P<0.05).The HCG improve⁃ment rate was 92.6%(52/56)in the study group,which was slightly higher than 82.50%(33/40)in the control group with no statistical difference(P>0.05).Levels of sex hormones follicle-stimulating hormone(FSH),luteinizing hormone(LH)and es⁃tradiol(E2)were(6.42±1.93)IU/L,(4.59±1.86)IU/L and(144.48±42.10)pmol/L in the study group,which presented no significant difference with(6.08±1.48)IU/L,(5.31±1.80)IU/L and(159.59±53.19)pmol/L in the control group(P>0.05).Before treatment,the scores of anxiety and quality of life were(57.49±6.78)points and(69.49±4.78)points in the study group,which demonstrated no significant difference with(57.49±6.78)points and(70.03±4.57)points in the control group(P>0.05).After treatment,the anxiety score was decreased in both groups,and the post-treatment anxiety score was(37.48±4.36)points in the study group,which was significantly lower than(44.65±4.69)points in the control group(P<0.05).Meantime,the quality of life score was increased in both groups,and the score was(89.45±7.26)points in the study group,which was significantly higher than(82.39±11.46)points in the control group(P<0.05).Two-month follow-up de⁃noted that there was 1 case(1.79%)of intrauterine infection and 1 case(1.79%)of menstrual irregularities in the study group,while there were 3 cases(7.50%)of intrauterine infection,1 case(2.50%)of intrauterine adhesion and 4 cases(10.00%)of menstrual irregularities in the control group.The incidence of adverse reactions was 3.57%in the study group,which was lower than 20.00%in the control group(P<0.05).Conclusion Application of Modified Tuohua Decoction combined with misoprostol on incomplete abortion can effectively shorten the vaginal bleeding cessation time and menstrual recovery time,promote restoration of the endometrium,accelerate the uterus functional recovery,reduce adverse reaction rates,improve the quality of life,and release the physiological and psychological burden.