| 杨琳;左文婷.益肾安胎化瘀方对肾虚血瘀型早期先兆流产合并绒毛膜下血肿患者凝血指标及妊娠结局的影响[J].,2024,44(1):31-36 |
| 益肾安胎化瘀方对肾虚血瘀型早期先兆流产合并绒毛膜下血肿患者凝血指标及妊娠结局的影响 |
| Effects of Yishen Antai Huayu Recipe on Coagulation Indicators and Pregnancy Outcomes for Early Threatened Abortion Complicated Subchorionic Hematoma Patients with Shen Deficiency Blood Stasis Syndrome |
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| DOI：10.7661/j.cjim.20231117.340 |
| 中文关键词: 益肾安胎化瘀方 肾虚血瘀 先兆流产合并绒毛膜下血肿 凝血指标 妊娠结局 中西医结合 |
| 英文关键词:Yishen Antai Huayu Recipe Shen deficiency blood stasis threatened abortion with subchorionic hematoma coagulation indicator pregnancy outcome integrative medicine |
| 基金项目:江苏省中医药管理局课题（No.JD2023SZ07）;江苏省中医院院级课题（No.Y21018） |
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| 中文摘要: |
| 目的 回顾性分析益肾安胎化瘀方联合孕激素对肾虚血瘀型先兆流产合并绒毛膜下血肿 （SCH）患者的妊娠结局及凝血指标的影响。方法 92例诊断为早期先兆流产合并绒毛膜下血肿的患者（肾虚血瘀型），根据入院后有无使用中药，分为观察组和对照组，每组46 例，观察两组临床疗效有效率、SCH面积、孕三项、凝血指标及妊娠结局。结果 （1）临床有效率及中医主、次症状评分：观察组临床总有效率93.48%（43/46），对照组52.17%（24/46），两组比较，差异有统计学意义（χ2=39.864，P＜0.01）；与本组治疗前比较，观察组治疗7、14天后各主、次症状评分均显著下降（P＜0.01），对照组14天后阴道出血、夜尿频数、面色晦暗评分显著下降（P＜0.01）；组间比较，观察组治疗7、14天后各主、次症状评分均显著低于对照组（P＜0.01）；（2）SCH、SCH面积/孕囊（GS）面积比值、孕三项、凝血指标及子宫动脉阻力指数（RI）：与本组治疗前比较，治疗7天后，观察组SCH、SCH/GS、子宫动脉RI均显著降低（P＜0.05），血雌二醇（E2）、β-人绒毛膜促性腺激素（β-HCG）显著升高（P＜0.05），对照组SCH/GS显著降低（P＜0.05），E2、β-HCG显著升高（P＜0.05）；治疗14天后，观察组SCH、SCH/GS、血浆D-二聚体（D-D）、血小板聚集率（ADP）、RI显著降低（P＜0.05），E2、孕酮（P）、β-HCG显著升高（P＜0.05），对照组SCH、SCH/GS显著降低（P＜0.05）。组间比较，观察组显著优于对照组（P＜0.05）。（3）两组住院天数观察组（7.63±3.49）天，对照组（9.47±4.77）天，阴道血止时间观察组（3.17±2.14）天，对照组（4.41±2.05）天，观察组住院天数、阴道血止时间均显著低于对照组（t1=2.122，t2=2.834， P＜0.05）；（4）观察组足月产率[84.78%（39/46）]高于对照组[56.52% （26/46）]，早产率[6.52% （3/46）]低于对照组[17.39% （8/46）]，流产率[8.69%（4/46）]低于对照组[26.09%（12/46）]，其中足月产率、流产率比较，差异有统计学意义（χ21=4.842，P＜0.05；χ22=8.859，P＜0.01）。结论 益肾安胎化瘀方联合地屈孕酮、黄体酮注射液对肾虚血瘀型早期先兆流产合并SCH患者，能缩短阴道出血时间，促进SCH吸收，改善凝血功能，降低子宫动脉RI，促进P、β-HCG的分泌，从而减少住院天数，降低流产率、早产率，提高足月产率。 |
| 英文摘要: |
| Objective To retrospectively analyze the effects of Yishen Antai Huayu Recipe （YAHR） combined with progesterone on coagulation indicators and pregnancy outcomes for early threatened abortion complicated subchorionic hematoma （SCH） patients with Shen deficiency blood stasis syndrome （SDBSS）. Methods Totally 92 early threatened abortion complicated SCH patients with SDBSS were assigned to observation group and control group according to whether they had used Chinese medicine （CM） after admission， 46 cases in each group. The clinical efficacy， subchorionic hematoma area， estradiol （E2），progesterone （P）， beta-human chorionic gonadotropin （β-HCG）， coagulation indicators， and pregnancy outcomes were observed in the two groups. Results （1） Clinical efficacy， CM primary and secondary symptoms scores： The total clinical efficacy was 93.48% （43/46 cases） in the observation group and 52.17% （24/46 cases） in the control group， with insignificant difference between the two groups （χ2=39.864，P＜0.01）. The primary and secondary symptoms scores significantly decreased after 7 and 14 days of treatment in the observation group （P＜0.01）. The scores of vaginal bleeding， frequent nocturia， and dark complexion decreased significantly after 14 days in the control group （P＜0.01）. （2） SCH， SCH area/gestational sac area （SCH/GS area）， E2， P， β-HCG， coagulation indicators， and uterine arterial resistance index： After 7 days of treatment， SCH， SCH/GS area， and resistance index （RI） significantly decreased （P＜0.05）， E2 and β-HCG significantly increased （P＜0.05） in the observation group. SCH/GS significantly decreased （P＜0.05）， E2 and β-HCG significantly increased （P＜0.05） in the control group. After 14 days of treatment SCH，SCH/GS area， D-dimer （D-D）， adenosine diphosphate （ADP）， and resistance index （RI） significantly decreased， E2， P， and β-HCG significantly increased （P＜0.05） in the observation group. SCH and SCH/GS area significantly decreased in the control group （P＜0.05）. All the inter-group indicators were significantly better in the observation group than in the control group （P＜0.05）. （3） The hospitalization days was （7.63±3.49） days in the observation group and （9.47±4.77） days in the control group. The time to stop vaginal bleeding was （3.17±2.14） days in the observation group and （4.41±2.05） days in the control group. The hospitalization days and the time to stop vaginal bleeding were significantly shorter in the observation group than in the control group （t1=2.122， t2=2.834，P＜0.05）.（4） The full-term birth rate of the observation group [84.78% （39/46）] was higher than that of the control group [56.52% （26 / 46）]. The premature birth rate [6.52% （3/46）] and the miscarriage rate [8.69% （4/46）] were lower in the observation group than in the control group [17.39% （8/46）； 26.09% （12/46）]. There were statistical differences in term birth rate and abortion rate between the two groups （P＜0.01）. Conclusion YAHR combined with Dydrogesterone Injection and Progesterone Injection shortened the time of vaginal bleeding， promoted SCH absorption， improved blood coagulation function， reduced uterine artery resistance， promoted the secretion of P and β-HCG of early threatened abortion complicated SCH patients with SDBSS， thereby lowering the number hospitalization days，reducing the rates of miscarriage and premature delivery， and elevating the rate of full-term delivery. |
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