基于“久病入络”理论探讨当归芍药散对早期复发性流产孕前干预疗效的影响  

A study on the effect of Danggui Shaoyao Powder on the pre-pregnancy intervention of early recurrent abortion based on the theory of"chronic diseases in collaterals"

作　　者：叶咏菊[1] 程慧芳 江伟华[1] 石明晴[1] YE Yong-ju;CHENG Hui-fang;JIANG Wei-hua;SHI Ming-qing(Department of Obstetrics and Gynecology,Lishui Hospital of Traditional Chinese Medicine,Lishui,Zhejiang 323000,China)

机构地区：[1]丽水市中医院妇产科,浙江丽水323000

出　　处：《中华全科医学》2020年第5期794-796,881,共4页Chinese Journal of General Practice

基　　金：浙江省中医药科技计划项目(2017ZB101,2020ZB297)。

摘　　要：目的探讨以"久病入络"为理论基础,研究应用当归芍药散对早期复发性流产孕前干预疗效的影响。方法采用回顾性研究方法,选取于2015年2月-2017年8月在丽水市中医院门诊就诊的被诊断为肝郁脾虚、瘀血内阻型早期复发性流产患者60例,以"久病入络"为理论基础采用当归芍药散加减进行治疗,疗程结束时,总结60例患者完成疗程时的治疗转归,分析影响治疗转归的因素。结果60例患者疗程结束时,19例(31.67%)成功实现自然妊娠。对影响治疗转归的相关因素进行分析,包括年龄、病程的长短、自然流产次数、子宫内膜类型、子宫动脉血流情况等,采用χ^2检验发现,自然流产次数(P=0.013)、子宫内膜类型(P=0.027)、子宫动脉血流是否异常(P=0.034)、中医主要证候积分(P<0.001)、治疗过程中子宫内膜、动脉血流及中医证候积分是否好转(P<0.05)与治疗转归具有相关性,但病程(P=0.558)与治疗结局无关;进一步经logistic回归分析发现,子宫内膜C型(P=0.027)、子宫动脉血流异常(P=0.034)、中医主要证候积分≥4分(P=0.001)是该证型治疗不良结局的独立危险因素。结论基于"久病入络"理论的精准辨证治疗可降低复发性流产患者中医证候积分,显著提高临床疗效。Objective To investigate the effect of Danggui Shaoyao Powder on the pre-pregnancy intervention of early recurrent abortion based on the theory of"chronic diseases in collaterals".Methods Using retrospective research method,60 patients with early recurrent abortion of liver stagnation and spleen deficiency and syndrome of internal blockade of static blood syndrome in the outpatient department of our hospital from February 2015 to August 2017.Based on the theory of"chronic diseases in collaterals",Danggui Shaoyao Powder was added and subtracted for treatment.At the end of the treatment course,the treatment outcome of 60 patients was summarized,and the factors influencing the treatment outcome were analyzed.Results At the end of the course of treatment,19 patients(31.67%)successfully achieved a natural pregnancy.The results ofχ^2 analysis shown that the number of spontaneous abortion(P=0.013),endometrial type(P=0.027),the abnormal uterine artery blood flow(P=0.034),the main syndrome score of TCM(P<0.001),and the improved endometrium,artery blood flow and the syndrome score of TCM(P<0.05)were correlated with the outcome of treatment,but the course of disease(P=0.558)was not related.Furthermore,logistic regression analysis showed that endometrial type C(P=0.027),abnormal uterine artery blood flow(P=0.034)and TCM main syndrome score≥4(P=0.001)were independent risk factors for the adverse outcome of the treatment.Conclusion The precise syndrome differentiation based on the theory of"chronic diseases in collaterals"can reduce the TCM syndrome scores,significantly improve clinical efficacy.

关 键 词：久病入络 孕前干预 当归芍药散 疗效影响 

分 类 号：R243[医药卫生—中医临床基础] R271[医药卫生—中医学]