補腎活血法聯合地屈孕酮片治療先兆流產合并宮腔積血

皮阿瓊 周瓊 曾誠

摘要 目的：探討補腎活血法聯合地屈孕酮片治療先兆流產合并宮腔積血的臨床療效。方法：選取2017年9月至2020年3月廣州中醫藥大學第一附屬醫院收治的先兆流產合并宮腔積血患者60例作為研究對象，按照隨機數字表法隨機分為對照組和觀察組，每組30例。觀察組給予補腎活血方+地屈孕酮片口服，對照組給予補腎活血方口服，觀察2組治療前后中醫主次證候總積分、胚芽長度、宮腔積血面積、妊娠3項水平變化，并比較2組治療后的療效，分析痛經史與治療結局的相關性。結果：2組治療后中醫主次證候總積分、宮腔積血面積、胚芽長度、孕酮水均較治療前改善，與治療前比較，差異均有統計學意義（均P<0.05）。觀察組有效率為83.3%，對照組為73.3%，2組比較差異有統計學意義（P<0.05）。結論：單用中藥及中西藥聯合治療均能改善患者臨床癥狀，縮小宮腔積血面積，提高孕酮水平，促進胚胎生長發育，中西藥聯合的臨床療效優于單用中藥。患者的痛經史與臨床療效具有一定的相關性，無痛經史者臨床療效好。

關鍵詞 先兆流產;宮腔積血;絨毛膜下血腫;補腎活血法;地屈孕酮片;痛經;壽胎丸

Clinical Observation on Bushen Huoxue Formula Combined with Dydrogesterone Tablet in the Treatment of Threatened Abortion with Intrauterine Hemorrhage

PI Aqiong1，ZHOU Qiong1，ZENG Cheng2

（1 The First Clinical Medical School of Guangzhou University of Chinese Medicine，Guangzhou 510000，China; 2 The First Affiliated Hospital of Guangzhou University of Chinese Medicine，Guangzhou 510000，China）

Abstract Objective：To explore the clinical effect of Bushen Huoxue Therapy combined with Dydrogesterone tablets in the treatment of threatened abortion with hematocele.Methods：From September 2017 to March 2020，a total of 60 patients with threatened abortion and hematopoietic uterus who were admitted to the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine were selected as the research objects.According to the random number table method，they were randomly divided into a control group and an observation group，with 30 cases in each group.The observation group was given Oral Bushen Huoxue Decoction+Dydrogesterone tablets，and the control group was given Oral Bushen Huoxue Decoction.The total scores of the primary and secondary syndromes of traditional Chinese medicine before and after treatment，the germ length，the area of uterine hemorrhage，and pregnancy were compared and compared in the 2 groups.The correlation between the history of dysmenorrhea and the outcome of treatment was analyzed.Results：After treatment，the total score of TCM primary and secondary syndrome，uterine hemorrhage，germ length and progesterone level in the 2 groups were improved as compared with those before treatment，and the difference was statistically significant（P<0.05）.The effective rates of the observation group and the control group were 83.3% and 73.3% respectively，and the clinical effect of the former was better than that of the latter（P<0.05）.Conclusion：The use of singal Chinese medicinal and the combination of traditional Chinese and Western medicine in the treatment of threatened abortion with uterine hemorrhage can improve the clinical symptoms，reduce the area of uterine hemorrhage，increase the level of progesterone and promote the growth of embryo.The clinical effect of combination of traditional Chinese and Western medicine is better than that of traditional Chinese medicine alone.The dysmenorrhea history of patients has certain correlation with clinical efficacy，patients without dysmenorrhea has better clinical efficacy.

Keywords Uterine hemorrhage; Hemorrhage in the uterus; Subchorionic hematoma; Method of invigorating the kidney and promoting blood circulation; Dydrogesterone tablets; Dysmenorrhea; Shoutai Pills

中圖分類號：R271.9文獻標識碼：Adoi：10.3969/j.issn.1673-7202.2022.03.020

早期先兆流產是指在發生在妊娠12周前的先兆流產，主要癥狀為孕婦出現少量陰道流血、下腹部陣痛或腰酸，婦科檢查宮頸口未開、胎膜未破，無妊娠相關的組織物排出[1]。陰道流血在妊娠早期的發生率為16%～25%，其中宮腔積血是導致早期妊娠陰道流血的最常見原因[2]，也有部分患者表現為下腹痛或無明顯癥狀，僅超聲檢查發現孕囊附近有無回聲的液性暗區，提示宮腔積血。……