當歸芍藥散加減治療早期復發性流產血栓前狀態臨床研究

林麗娜　李淑萍　袁杰

摘要：目的 ?探討當歸芍藥散加減對早期復發性流產血栓前狀態患者中醫證候及血液指標影響，觀察保胎成功率。方法 ?采用隨機數字表法將76例早期復發性流產血栓前狀態患者分為對照組和觀察組各38例。對照組予低分子肝素鈣注射液，每日1次，每次4000 IU，皮下注射。觀察組在對照組基礎上予當歸芍藥散加減，每日1劑，每日2次，口服。2組均30 d為1個療程，連續治療2個療程。比較2組治療前后中醫證候積分，凝血四項[活化部分凝血活酶時間（APTT）、凝血酶時間（TT）、凝血酶原時間（PT）、纖維蛋白原（FIB）]、血小板聚集率、血清孕酮和絨毛膜促性腺激素（β-HCG）水平，比較2組保胎成功率。結果 ?與本組治療前比較，2組治療后中醫證候積分明顯降低（P<0.05）;2組治療后比較，觀察組中醫證候積分明顯低于對照組（P<0.05）。與本組治療前比較，2組治療后APTT、PT、TT明顯延長（P<0.05），FIB水平明顯降低（P<0.05）;觀察組治療后APTT、PT、TT明顯長于對照組，FIB水平明顯低于對照組（P<0.05）。觀察組治療后血小板聚集率正常率為77.14%（27/38），對照組為41.18%（14/38），觀察組明顯高于對照組（P<0.05）。與本組治療前比較，2組治療后孕酮水平升高（P<0.05）;2組治療后比較，觀察組孕酮水平高于對照組（P<0.05）。觀察組保胎成功率為65.79%（25/38），對照組為36.84%（14/38），觀察組明顯高于對照組（P<0.05）。結論 ?當歸芍藥散加減可有效改善患者臨床證候，提升孕酮水平，提高保胎成功率。

關鍵詞：當歸芍藥散;早期復發性流產;血栓前狀態;凝血四項;保胎

中圖分類號：R271.942.1 ???文獻標識碼：A??? 文章編號：1005-5304（2020）01-0029-04

DOI：10.3969/j.issn.1005-5304.201904255

Clinical Study on Modified Danggui Shaoyao Powder for Treatment of Patients with Early Recurrent Abortion before Thrombosis

LIN Lina， LI Shuping， YUAN Jie

Changzhou Traditional Chinese Medicine Hospital， Changzhou 213002， China

Abstract： Objective To explore the effects of modified Danggui Shaoyao Powder on the clinical symptoms and blood indexes of patients with early recurrent abortion before thrombosis and fetus protection success rate. Methods Totally 76 patients with early recurrent abortion before thrombosis were divided into control group and observation group according to random number table method， with 38 cases in each group. The control group was treated with low molecular weight heparin calcium injection， while the observation group was treated with modified Danggui Shaoyao Powder on the basis of the control group， one dosage per day， twice a day， orally. 30 d were one treatment course for both groups， for consecutive two courses. TCM symptom scores， coagulation four [activated partial thromboplastin time （APTT）， thrombin time （TT）， prothrombin time （PT）， fibrinogen （FIB）]， platelet aggregation rate， serum progesterone and β-human chorionic gonadotropin （β-HCG） level before and after treatment in both groups were compared， and fetus protection success rates were compared. Results Compared with before treatment， TCM symptom scores in the two groups were significantly reduced （P<0.05）; After treatment， TCM symptom score in the observation group was significantly lower than that in the control group （P<0.05）. Compared with before treatment， the APTT， PT and TT in the two groups increased after treatment， and the FIB level in the two groups decreased; After treatment， the APTT， PT and TT in the observation group were significantly longer than those in the control group， and the FIB level was significantly lower than that in the control group （P<0.05）. The normal rate of platelet aggregation rate in the observation group was 77.14% （27/38）， and that in the control group was 41.18% （14/38）. The observation group was significantly higher than the control group （P<0.05）. Compared with before treatment， the progesterone level in the two groups increased after treatment （P<0.05）. The progesterone level in the observation group was higher than that in the control group （P<0.05）. The fetus protection success rate in the observation group was 65.79% （25/38）， and that in the control group was 36.84% （14/38）. The observation group was significantly higher than the control group （P<0.05）. Conclusion Modified Danggui Shaoyao Powder can effectively improve the clinical symptoms of patients， increase progesterone levels， and improve fetus protection success rate.

Keywords： Danggui Shaoyao Powder; early recurrent abortion; before thrombosis; coagulation four; fetus protection

血栓前狀態是指患者纖溶系統、凝血與抗凝系統出現障礙^[1-2]，高凝血液導致子宮胎盤組織血液流變學出現變化，局部組織出現微血栓，胎盤血供能力降低，胎兒處于缺氧、缺血狀態，導致胎兒因發育不良而流產。復發性流產（recurrent abortion，RSA）指2次或2次以上在妊娠28周前的胎兒丟失^[1]。《靈樞·邪氣藏府病形》“有所墜墮，惡血內留”，即提出母體胞宮有血瘀、癥瘕而引起墮胎。當歸芍藥散配合補腎之品，可養血健脾益氣，以助生化之源，使氣旺而載胎。同時，氣旺能行血，有助于瘀血消散，有效調節氣血運行，使胎元有所依附，起到壯母固胎安痛之效^[3-6]。本研究觀察當歸芍藥散加減對早期RSA血栓前狀態患者臨床療效，現報道如下。……