脱花煎加味对疤痕妊娠患者经动脉栓塞后清宫治疗的出血防治效果及预后影响  

Efficacy of Modified Tuohua Decoction on Bleeding Prevention and Prognosis of Curettage after Uterine Artery Embolization in Patients with Cesarean Scar Pregnancy

作　　者：王丹凤 徐应利 季莉 翁兆银 WANG Dan-feng;XU Ying-li;JI Li;WENG Zhao-yin(Department of Obstetrics and Gynecology,Lu'an Hospital of Traditional Chinese Medicine,Lu'an Anbui 237006)

机构地区：[1]六安市中医院妇产科,安徽六安237006

出　　处：《世界中西医结合杂志》2022年第4期774-777,782,共5页World Journal of Integrated Traditional and Western Medicine

基　　金：2018年度安徽省卫生计生委中医药科研计划课题(2018zy152)。

摘　　要：目的 探讨脱花煎加味对疤痕妊娠(Cesarean scar pregnancy, CSP)患者经子宫动脉栓塞(Uterine artery embolization, UAE)后清宫治疗的出血防治效果及对预后的影响。方法 选取2018年8月—2020年3月期间六安市中医院妇产科收治的CSP患者104例,根据随机数字表法分为对照组和治疗组,每组各52例。对照组先行UAE,并于24 h后行清宫术治疗,治疗组在对照组基础上于UAE术前7 d给予脱花煎加味治疗。治疗后观察比较两组患者临床疗效,阴道出血量,阴道出血持续时间,血清β绒毛膜促性腺激素-(βhuman chorionic gonadotrophin,β-HCG)水平及恢复正常时间、月经复潮时间。记录两组患者治疗期间及术后1周不良反应,随访1年,比较两组患者月经病及妊娠情况。结果 治疗后治疗组总有效率为96.15%(50/52)明显高于对照组82.35%(42/51),差异有统计学意义(P<0.05)。治疗后治疗组清宫时间、清宫出血量、术后阴道出血时间均明显低于对照组,差异有统计学意义(P<0.05)。治疗后治疗组术后1周血清β-HCG水平、β-HCG恢复正常时间、月经复潮时间均低于对照组,差异有统计学意义(P<0.05)。治疗期间及术后1周,两组患者呕吐、腹泻、腹痛等不良反应总发生率比较,差异无统计学意义(P>0.05)。随访1年,治疗组月经病总发生率为19.23%明显低于对照组37.25,差异有统计学意义(P<0.05)。随访1年,治疗组再妊娠率为51.92%明显高于对照组31.37%,治疗组CSP再发生率和流产率均明显低于对照组,差异有统计学意义(P<0.05)。结论 脱花煎加味可明显提高CSP患者的治疗效果,缩短清宫术及术后出血时间,对UAE后清宫术中出血的发生有较好防治作用,并能促进各项指标的尽早恢复,减轻手术损伤,使患者获得较佳的远期预后。Objective To explore the efficacy of modified Tuohua Decoction on bleeding prevention and prognosis of curettage after uterine artery embolization(UAE)in patients with cesarean scar pregnancy(CSP).Methods A total of 104 CSP patients treated in the department of obstetrics and gynecology ofLu′an Hospital of Traditional Chinese Medicinefrom August 2018 to March 2020 were enrolled and divided into a control group(n=52)and a treatment group(n=52)based on a random number table.All patients received UAE first, followed by curettage 24 hours later, and those in the treatment group wereadditionally treated with modified TuohuaDecoction 7 days before UAE.After treatment, the clinical efficacies, vaginal bleeding, the durationof vaginal bleeding, the serum β human chorionic gonadotropin(β-HCG)level, the time for β-HCGto return to normal, and the time to menstrual regain of the two groups were compared.During the treatment and oneweek after the operation, adverse reactions were recorded.The patients were followed up for oneyear, and the menstrual diseases and pregnancy conditions were compared.Results After treatment, the total effective rate of the treatment group was 96.15%(50/52),higher than 82.35%(42/51)of the control group(P<0.05).Thecurettage time, vaginal bleeding during curettage, and postoperative vaginal bleeding time in the treatment group were lower than those in the control group(P<0.05).After treatment, the serum β-HCG level one week after the operation, the time for β-HCG to return to normal, and the time for menstrual regain in the treatment group were lower than those in the control group(P<0.05).During the treatment period and oneweek after the operation, the incidence of adverse reactions, such as vomiting, diarrhea, and abdominal pain, between the two groups was not statistically different(P>0.05).In the follow-up for oneyear, the incidenceof menstrual diseases in the treatment group was 19.23%,lower than 37.25%in the control group(P<0.05).In the follow-up for one year, the re-pregnancy rate of th

关 键 词：疤痕妊娠 子宫动脉栓塞 清宫术 脱花煎 预后 

分 类 号：R711.52[医药卫生—妇产科学]