辨证选用中药宫腔灌注治疗输卵管性不孕的临床效果及对动脉血流的影响  

Clinical efficacy of intrauterine infusion with Chinese medicine based on syndrome differentiation for tubal infertility

作　　者：孟凤云 易蕾 MENG Feng-yun;YI Lei(Department of Gynaecology,Nanning Hospital of Traditional Chinese Medicine,Nanning 530014,China)

机构地区：[1]广西南宁市中医医院妇科,南宁市530014

出　　处：《广西医学》2018年第6期619-621,625,共4页Guangxi Medical Journal

基　　金：广西医药卫生科研课题(Z2016569)

摘　　要：目的观察辨证选用中药宫腔灌注治疗输卵管性不孕的临床效果及对动脉血流的影响。方法将60例输卵管性不孕患者随机分为观察组32例及对照组28例,对照组采用地塞米松+庆大霉素+生理盐水混合液宫腔注药,观察组在对照组的基础上根据辨证选用丹参或红花注射液宫腔注药。比较两组治疗前后子宫动脉的血流动力学指标[血流搏动指数(PI)、阻力指数(RI)及收缩期峰值流速/舒张末期流速(S/D)]、输卵管通畅性、子宫内膜厚度以及1年内的妊娠结局。结果治疗后,两组RI及S/D值均较前降低(均P<0.05),而观察组RI及S/D值均低于对照组(均P<0.05);两组子宫内膜厚度均增加(均P<0.05),且观察组子宫内膜厚度厚于对照组(P<0.05);两组通畅性输卵管比例增加(P<0.05),但治疗后两组间比较差异无统计学意义(P>0.05)。观察组的活胎率高于对照组,而流产率及异位妊娠率低于对照组(均P<0.05)。结论辩证使用活血化瘀药物行宫腔灌注,不仅可机械性疏通输卵管,还可更好地改善子宫动脉血流动力学,进而改善输卵管及子宫内膜微环境,增加患者的宫内活胎妊娠率,降低不良妊娠率。Objective To explore the clinical efficacy and impacts on arterial blood flow of intrauterine infusion with Chinese medicine based on syndrome differentiation for tubal infertility.Methods Sixty patients with tubal infertility were randomly divided into observation group(n=32)and control group(n=28).Intrauterine infusion with the mixture of dexamethasone,gentamicin and normal saline was conducted in the control group.Intrauterine infusion with salvia miltrorrhiza or flowers carthami for injection according to syndrome differentiation was conducted in the observation group on the basis of the therapy of the control group.Before and after treatment,the hemodynamic indices of uterine artery[including pulsatility index(PI),resistance index(RI)and systolic peak velocity/diastolic velocity(S/D)],patency of fallopian tube,endometrial thickness and pregnancy outcome within one year were compared between the two groups.Results After treatment,RI and S/D value decreased in both groups compared to the previous(all P<0.05),and RI and S/D value of the observation group were lower than those of the control group(all P<0.05);the endometrial thickness increased in both groups(all P<0.05),and the thickness of the observation group was thicker than that of the control group(P<0.05);the proportion of cases with unobstructed fallopian tube increased in both groups(P<0.05),but no significant difference was found between the two groups(P>0.05).The rate of live births was higher,but the rates of abortion and ectopic pregnancy were lower in the observation group compared to the control group(all P<0.05).Conclusion Intrauterine infusion using the drugs promoting blood circulation for removing blood stasis according to syndrome differentiation not only can achieve mechanical recanalization of fallopian tube,but also can better improve the hemodynamics of uterine artery,and then to improve the uterotubal and endometrial microenvironment,increase the rate of intrauterine pregnancy with live births and decrease the abnormal pregnancy rate.

关 键 词：输卵管性不孕 宫腔注药 中药 活血化瘀 子宫动脉 血流动力学 妊娠结局 子宫内膜厚度 

分 类 号：R711.6[医药卫生—妇产科学]