浅析医易会通-易经卦象课程思政——以滑胎为例

目的 基于《周易》中蕴藏的哲学辩证和象数思维模式,将易经卦理融入中医妇科学理论知识中,并尝试对其进行思政化。方法 授课中以屯卦的卦象、卦义解释生命初始之复杂的生殖理论。以既济、未济二卦切入滑胎“预培其损”的临证应用,引导学生在卦理中筑德修心。结果 比类取象,以熟识的水火、草木生长之“象”诠释晦涩难懂的中医藏象之“意”;将卦义、卦理引入复杂的病因病机及诊疗思路中,使中医妇科理论知识学习简单化、趣味化。结论 学生在更好地理解和掌握专业知识的同时,领悟先人智慧,学会经世之道,建立文化自信。

中医预培其损序贯疗法对胚胎反复移植失败患者新鲜周期相关指标的影响

目的探讨中医(补肾健脾)预培其损序贯疗法对胚胎反复移植失败(repeated implantation fail-ure,RIF)患者新鲜周期相关指标的影响。方法将既往行体外受精-胚胎移植(in virto fertilization and em-bryo transfer,IVF-ET)或卵母细胞单精子显微注射(intracytoplasmic sperm injection,ICSI)失败3次及以上的患者,行新鲜取卵/移植周期共60例,分为治疗组(中药结合IVF/ICSI)与对照组(单纯IVF/ICSI),每组30例,比较两组外源性促性腺激素(gonadotropin,Gn)用量、超排卵(controlled ovarian hyperstimulation,COH)时间、移植日子宫内膜厚度、获得卵数、受精数、胚胎数、优质胚胎数、妊娠率及种植率等各项指标的差异。结果治疗组单周期人均获得胚胎(7.5±4.9)个,优质胚胎(5.1±3.8)个,两者较对照组(5.1±3.2,3.2±1.8)均明显升高,差异均有统计学意义(P<0.05)。两组在Gn用量、COH天数、移植日子宫内膜厚度、获得卵数、受精数、妊娠率及种植率方面比较,差异均无统计学意义(P>0.05)。结论中医预培其损序贯疗法结合超排卵有利于胚胎数量和质量的双重提高,有望增加RIF患者的累计妊娠率。

中西医结合治疗宫内合并异位妊娠1例

宫内合并异位妊娠(Heterotopy Pregnancy,HP)是指宫腔内妊娠与异位妊娠同时存在,临床上较罕见[1]。本文就2015年黑龙江中医药大学附属第一医院遇到的一例宫内合并异位妊娠为例,探讨其发病及危险因素、诊断过程以及中西医结合特色治疗——在手术治疗的基础上进行中医辨证论治,并非一味地追求"以补为保",而是合理地利用化瘀药来增强保胎的效果,体现了中医"预培其损"原则。

Clinical Observations of Sequential Therapy with Chinese Medicine and Hysteroscopic Mechanical Stimulation of the Endometrium in Infertile Patients with Repeated Implantation Failure Undergoing Frozen-Thawed Embryo Transfer

Objectives： To investigate the clinical effect of sequential therapeutic intervention Yupei Qisun [compensating for weakness by invigorating Kidney （Shen） and Spleen （Pi） in advance] in Chinese medicine （CM） and hysteroscopic endometrial mechanical stimulation on the treatment of infertile patients with repeated implantation failure （RIF）; and to study the differences in patients＇ endometrial thickness and type on the day of embryo transfer, serum hormone levels on embryo transfer day and clinical pregnancy outcomes. Methods： In the clinical study, 168 frozen-thawed embryo transfer （FET） cycles for couples with RIF conforming to the research protocol were randomly divided into three groups： a CM group with 56 cycles （CM combined with FET）, a hysteroscopy group with 55 cycles （hysteroscopic endometfial mechanical stimulation）, and a control group with 57 cycles （conventional FET）. Differences in endometrial thickness on the embryo transfer day, levels of serum estradiol （E2） and progesterone （P） on the embryo transfer day, the E2/P ratio on the embryo transfer day, biochemical and clinical pregnancy rates, implantation rate, abnormal pregnancy rate and other indices were compared among the three groups. Results： Endometrial thickness, E2 and P levels, and the EJP ratio on embryo transfer day and other factors had no significant differences among groups. The biochemical pregnancy, clinical pregnancy, and implantation rates of the CM and hysteroscopy groups were significantly higher than the control group （P〈0.05）, and there were no significant differences between these two groups. The abnormal pregnancy rate had no significant difference among the three groups. Conclusions： Sequential therapy of Yupei Qisun could significantly improve the clinical outcomes of RIF-FET cycles, being equivalent to hysteroscopic endometrial mechanical stimulation, and provided a reliable method to treat such infertile couples.

“预培其损”针灸疗法治疗反复种植失败患者的临床观察

目的:研究“预培其损”针灸疗法对反复种植失败(RIF)患者的可行性和有效性。方法:分析2017年2月至2018年6月于郑州大学第一附属医院生殖与遗传专科医院行辅助生殖技术助孕治疗的106例RIF患者。根据针灸治疗前后分为治疗前组和治疗后组,这106例患者予“预培其损”针灸疗法治疗2个月,再行胚胎移植助孕治疗。观察治疗前后RIF患者中医肾虚证候及治疗后总临床妊娠率、高龄临床妊娠率、卵裂期胚胎临床妊娠率、囊胚临床妊娠率、异位妊娠率、流产率。结果:予“预培其损”针灸疗法治疗后,患者肾虚证候积分较治疗前显著降低(P<0.01)。总临床妊娠率、高龄临床妊娠率、卵裂期胚胎临床妊娠率、囊胚临床妊娠率、异位妊娠率、流产率分别为54.72%(58/106)、51.52%(17/33)、52.78%(38/72)、58.82%(20/34)、1.72%(1/58)、10.34%(6/58)。结论:“预培其损”针灸疗法显著降低RIF患者肾虚证候积分,缓解或消除患者的肾虚症状,提高患者生活质量。