“通元针法”分期施治对薄型子宫内膜反复种植失败患者妊娠结局的影响  

Effect of staging treatment of Tongyuan acupuncture on pregnancy outcome in patients with recurrent implantation failure of thin endometrium type

作　　者：薛红梅 李月梅[2] 陈雨婷 黎翠 张莹 金萍 李孟邻 林芸[4] XUE Hong-mei;LI Yue-mei;CHEN Yu-ting;LI Cui;ZHANG Ying;JIN Ping;LI Meng-lin;LIN Yun(First Clinical College of Guangzhou University of CM,Guangzhou 510499,Guangdong Province,China;Department of Acupuncture and Moxibustion,First Affiliated Hospital of Guangzhou University of CM,Guangzhou 510405,Guangdong Province;Department of Acupuncture and Moxibustion,Third Affiliated Hospital of Guangzhou University of CM;Guangdong People's Hospital)

机构地区：[1]广州中医药大学第一临床医学院,广东广州510499 [2]广州中医药大学第一附属医院针灸科,广东广州510405 [3]广州中医药大学第三附属医院针灸科 [4]广东省人民医院

出　　处：《中国针灸》2021年第12期1338-1342,共5页Chinese Acupuncture & Moxibustion

基　　金：广东省“登峰计划”高水平医院建设资助项目:211010010716。

摘　　要：目的:比较“通元针法”联合西药与单纯西药对薄型子宫内膜反复种植失败(RIF)患者妊娠结局的影响。方法:将74例拟行冻融胚胎移植的薄型子宫内膜RIF患者随机分为观察组(37例)和对照组(37例)。对照组采用激素替代周期的冻融胚胎移植,于月经来潮第5天起口服戊酸雌二醇片,每天2 mg;观察组在对照组基础上加用针灸“通元针法”处方,穴取百会、大椎、气海、关元等,配合辨证取穴及月经周期分期取穴,隔日1次,两组均治疗3个月经周期。于移植后观察两组患者临床妊娠率、胚胎种植率,于治疗前及移植前1 d检测两组子宫内膜厚度及类型、血流阻力指数(RI)及搏动指数(PI),并记录不良反应。结果:观察组临床妊娠率为37.8%(14/37),高于对照组的16.2%(6/37,P<0.05);两组胚胎种植率比较差异无统计学意义(P>0.05)。移植前1 d,两组子宫内膜厚度、子宫内膜类型中A型比例较治疗前增加(P<0.01),且观察组高于对照组(P<0.01,P<0.05);两组子宫内膜血流动力学指数PI、RI较治疗前降低(P<0.01),且观察组低于对照组(P<0.01,P<0.05)。治疗过程中对照组有6例患者出现乳房胀痛、胃痛、头晕、恶心等不适,观察组未出现药物不良反应。结论:在常规西药基础上,加用“通元针法”可增加薄型子宫内膜RIF患者子宫内膜厚度,提高子宫内膜容受性,改善妊娠结局,减少药物不良反应。Objective To compare the effect of Tongyuan acupuncture combined with medication and medication alone on pregnancy outcome in patients with recurrent implantation failure(RIF)of thin endometrium type.Methods A total of 74 patients with RIF of thin endometrium type undergoing freeze-thaw embryo transfer were randomly divided into an observation group(37 cases)and a control group(37 cases).The patients in the control group were treated with freeze-thaw embryo transfer in hormone replacement cycle,and the estradiol valerate tablets were taken orally from the fifth day of menstruation,2 mg per day.On the basis of the control group,the observation group was additionally treated with Tongyuan acupuncture at Baihui(GV 20),Dazhui(GV 14),Qihai(CV 6),Guanyuan(CV 4),etc.,combined with other acupoints based on syndrome differentiation and menstrual stage,once every other day.Both groups were treated for 3 menstrual cycles.The clinical pregnancy rate and embryo implantation rate of the two groups were observed after transplantation;the endometrial thickness and type,resistance index(RI)and pulsatility index(PI)of endometrial blood flow were measured before treatment and one day before transplantation,and adverse reactions was recorded.Results The clinical pregnancy rate was 37.8%(14/37)in the observation group,which was higher than 16.2%(6/37)in the control group(P<0.05).There was no significant difference in embryo implantation rate between the two groups(P>0.05).One day before transplantation,the endometrial thickness and the proportion of type A in endometrial classification in the two groups were increased compared with those before treatment(P<0.01),and those in the observation group were higher than the control group(P<0.01,P<0.05).The PI and RI of endometrial blood flow in the two groups were lower than those before treatment(P<0.01),and those in the observation group were lower than the control group(P<0.01,P<0.05).During the treatment,6 patients in the control group had discomfort such as breast distending pain,stoma

关 键 词：体外受精-胚胎移植 反复种植失败 薄型子宫内膜 通元针法 子宫内膜容受性 妊娠率 

分 类 号：R246.3[医药卫生—针灸推拿学]