抵挡汤合寿胎丸加减治疗不全流产临床观察

Clinical effect of modified Didang Decoction combined with Shoutai Pill for incomplete abortion

目的观察抵挡汤合寿胎丸加减治疗不全流产的临床疗效。方法将60例不全流产患者按照随机数字表法分为2组,对照组30例予米非司酮片联合产妇安颗粒治疗,治疗组30例予米非司酮片联合抵挡汤合寿胎丸加减治疗,2组均连用2周,随访3个月经周期。比较2组治疗1、2周疗效;比较2组阴道出血时间、月经复潮时间;比较2组治疗1周后血清人绒毛膜促性腺激素(β-HCG)水平变化;比较2组治疗前后子宫内膜厚度、子宫动脉血流参数变化;比较2组治疗前、随访时月经量评分、症状评分变化。结果治疗组治疗1周有效率86.7%(26/30),对照组治疗1周有效率70.0%(21/30),治疗组治疗1周疗效优于对照组(P<0.05)。治疗组治疗2周总有效率100%(30/30),对照组治疗2周总有效率96.7%(29/30),2组治疗2周疗效比较差异无统计学意义(P>0.05)。治疗组阴道出血时间少于对照组(P<0.05);2组月经复潮时间均推后,比较差异无统计学意义(P>0.05)。2组平均血清β-HCG水平比较差异无统计学意义(P>0.05)。治疗1周后2组子宫内膜厚度比较差异无统计学意义(P>0.05);治疗2周后2组子宫内膜厚度均较本组治疗1周后增加(P<0.05),治疗组治疗2周后子宫内膜厚度大于对照组(P<0.05)。2组治疗后子宫动脉血流阻力指数(RI)、子宫动脉搏动指数(PI)、螺旋动脉收缩期峰值流速/舒张末期峰值流速(S/D)水平均较本组治疗前改善(P<0.05);治疗后治疗组RI、PI、S/D改善均优于对照组(P<0.05)。治疗组治疗前与随访时月经量评分比较差异无统计学意义(P>0.05);对照组随访时月经量评分较本组治疗前减少(P<0.05);2组随访时月经量评分比较差异有统计学意义(P<0.05)。与本组治疗前比较,随访时治疗组小腹胀痛、腰骶酸痛、乳房胀痛评分和总评分降低(P<0.05),对照组小腹胀痛、腰骶酸痛、月经后期评分和总评分升高(P<0.05);2组随访时小腹胀痛、腰骶酸痛、月经后期评分和总评分比较差异均有统计学意义(P<0.05)。结论抵挡汤合寿胎丸加减治疗不全流产,可缩短阴道出血时间,降低血清β-HCG水平,促进子宫内膜修复,改善子宫动脉血流参数。

Objective To observe the clinical effect of modified Didang Decoction combined with Shoutai Pill for incomplete abortion(IA).Methods Sixty IA patients were randomly assigned into the treatment group(n=30)and the control group(n=30).Mifepristone was applied to all recruited patients,and those in the control group and the treatment group were additionally managed by Chanfuan granules and modified Didang Decoction combined with Shoutai Pill,respectively.After treatment for 2 weeks,the vaginal bleeding time and menstrual recovery time were recorded,the changes in beta-human chorionic gonadotropin(β-hCG),endometrial thickness and uterine artery blood flow parameters on week 1were compared,and the changes in menstrual volume before treatment and during follow-up,and traditional Chinese medicine(TCM)syndrome score before and after treatment were counted between groups,The curative effect on weeks 1 and 2 was assessed.Results The effective rate on week 1 was better in the treatment group(compared with the control group(86.7%[26/30])vs 70.0%[21/30],(P<0.05).The difference was no statistically significant in the overall effective rate on week 2 between the treatment group and the control group(100%[30/30]vs 96.7%[29/30],[P>0.05],respectively).The vaginal bleeding time was significantly shorter in the treatment group than in the control group(P<0.05).While,the menstrual recovery time in the both groups was delayed,and with no statistically significant difference(P>0.05).No difference in the mean level of serumβ-hCG differed significantly between groups(P>0.05).None of the endometrial thickness on week 1 differed significantly between groups(P>0.05).The endometrial thickness on week 2 in the both groups was significantly increased than that on week 1(P<0.05),which,on week 2,was significantly higher in the treatment group than that of the control group(P<0.05).After treatment,resistance index(RI)of uterine artery blood flow,pulsatility index(PI)of uterine artery,peak systolic velocity/end diastolic velocity(S/D)of helicine arteries in the both groups significantly improved(P<0.05),the improvements in the treatment group were significantly better than those of the control group(P<0.05).The difference was no statistically significant in the menstrual volume score before treatment and during follow-up in the treatment group(P>0.05).The menstrual volume score during follow-up in the control group was significantly lower than that before treatment(P<0.05).There was significant difference in the menstrual volume score during follow-up between groups(P<0.05).During follow-up,patients in the treatment group had significantly lower TCM syndrome(abdominal distension pain,lumbosacral pain,breast distension pain)score than before treatment(P<0.05),but patients in the control group had significantly higher TCM syndrome(abdominal distension pain,lumbosacral pain,postmenstrua score)score(P<0.05)than before treatment.The difference was statistically significant in TCM syndrome(abdominal distension pain,lumbosacral pain,postmenstrua score)score between groups(P<0.05).Conclusion For IA patients,modified Didang Decoction combined with Shoutai Pill can shorten vaginal bleeding time,reduce serumβ-HCG level,promote endometrial regeneration,and improve uterine artery blood flow parameters.