中西医结合治疗妊娠期肝内胆汁淤积症初探

作者	单位
方静	西安交通大学医学院第一附属医院妇产科
苟文丽	西安交通大学医学院第一附属医院妇产科
李奇灵	西安交通大学医学院第一附属医院妇产科

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中文摘要:

目的评估复方丹参注射液联合熊去氧胆酸治疗妊娠期肝内胆汁淤积症的临床疗效及对新生儿预后的影响。方法选择妊娠期肝内胆汁淤积症患者128例,分成两组。治疗组72例采用复方丹参注射液(20mL加入10%葡萄糖注射液500mL静脉滴注,每天1次)和熊去氧胆酸[15mg/(kg.d),分3次口服]联合治疗;对照组56例采用熊去氧胆酸治疗;均以14天为1个疗程。观察两组治疗前后瘙痒评分、血清生化指标[甘胆酸(CG)、总胆红素(TBiL)、谷丙转氨酶(ALT)及谷草转氨酶(AST)]变化及分娩后比较两组围生儿情况。结果两组治疗后瘙痒评分均明显降低,治疗组由3.6分降至1.4分,对照组由3.4分降至1.6分,两组评分比较差异无统计学意义(P>0.05),但起效时间治疗组(4～6天)较对照组(8～10天)更快;两组血清CG、TBiL、ALT及AST均较治疗前下降(P<0.01),治疗组较对照组下降更明显,差异有统计学意义(P<0.05)。治疗后两组间胎儿窘迫、羊水粪染和新生儿窒息发生率比较,差异均无统计学意义(P>0.05);但新生儿体重治疗组[(3108±236)g]大于对照组[(2681±269)g],差异有统计学意义(P<0.05)。结论复方丹参注射液联合熊去氧胆酸治疗妊娠期肝内胆汁淤积症,疗效优于单用熊去氧胆酸治疗者。

英文摘要:

Objective To evaluate the therapeutic effect of compound salvia injection combined with ursodeoxycholic acid(UDCA)in treating pregnant women with intrahepatic cholestasis(ICP)and its influence on perinatal babies.Methods One hundred and twenty-eight patients of ICP were assigned to two groups.The 72 patients in the treatment group were treated with salvia injection(20 mL in 10% glucose 500 mL for intravenous dripping once a day)and UDCA(15 mg,thrice daily by oral taken),and the 56 patients in the control group were treated with UDCA alone,all were treated for 14 days.Changes of itching symptom(estimated by scoring)and serum levels of biochemical indexes,including alanine aminotransferase(ALT),aspartate amonitransferase(AST),bilirubin(TBil)and glycocholic acid(GCA),were determined before and after treatment,and conditions of the newborns were compared after delivery.Results Compared with before treatment,scores of itching were lowered from 3.6 scores to 1.4 scores in the treatment group,and from 3.4 scores to 1.6 scores in the control group,showing no significant difference between groups(P>0.05),but the lowering was shown earlier in the former.Levels of biochemical indexes were improved significantly(P<0.01)in both groups,but the improvements were more significant in the treatment group,the difference between groups was significant(P<0.05).The difference between groups in the incidence of fetal distress,meconium-stained fluid and neonatal asphysia were insignificant(P>0.05).The birth weights of the newborns were higher in the treatment group than in the control group(3 108±236 g vs 2 681±269 g,P<0.05).Conclusion The combined therapy of compound salvia injection and UDCA shows better effect in treating ICP than that of UDCA alone.

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