中医药诊治绒毛膜下血肿的研究进展  

A review on the traditional Chinese medicine diagnosis and treatment of subchorionic hematoma

作　　者：孙丽[1] 郑祖峰 SUN Li;ZHENG Zufeng

机构地区：[1]山东中医药大学,山东济南250013 [2]山东中医药大学第二附属医院,山东济南250001

出　　处：《中医临床研究》2023年第24期17-21,共5页Clinical Journal Of Chinese Medicine

摘　　要：绒毛膜下血肿(Subchorionic Hematoma,SCH)是指绒毛膜板和底蜕膜之间分离引起出血,超声表现为宫壁和孕囊之间的液性暗区。SCH的发病率在各项研究中差异很大。本病可无症状,在常规产科超声检查中发现,可能引起稽留流产等不良妊娠结局。本病属中医“胎漏”“胎动不安”等范围,中医药治疗本病有独特的优势和良好的疗效。现代医家认为,本病病因有脾虚、肾虚、阴虚、血瘀、血热等,与妇女的年龄、饮食、抗反转录病毒药物治疗过程、情志有关。在本病的治疗上,有较多方剂可供参考,如寿胎丸、安胎饮、四君子汤、四物汤等,临床上常使用补肾类、活血化瘀类、健脾类等药物治疗,高频药对有菟丝子-桑寄生-续断、黄芩-白术、菟丝子-覆盆子等。现代医家在临床过程中辨证施治,灵活化裁古方,或加安胎之品,或联合西药地屈孕酮、肝素等,效果颇佳。亦有医家结合自己的实际临床经验自拟保胎方,实行个体化治疗,疗效斐然。中医药治疗本病的机制尚未完全研究透彻,现有的研究表明,中医药有助于改善微循环,促进输卵管管腔修复,改善输卵管功能、盆腔环境及卵巢功能,增加子宫内膜厚度,降低血流阻力,改善患者阴道微环境,多方面发挥保胎作用,进而改善妊娠结局,提高活产率。Subchorionic hematoma(SCH)refers to the separation between the chorionic plate and the decidua basalis,causing bleeding.Ultrasound shows a liquid dark area between the uterine wall and the gestational sac.The incidence rate of SCH varies greatly in various studies.The disease can be asymptomatic,often found in routine obstetric ultrasound examination,which may lead to missed abortion and other adverse pregnancy outcomes.This disease belongs to the scope of“fetal leakage”and“fetal restlessness”in traditional Chinese medicine(TCM),and TCM treatment has unique advantages and good therapeutic effects.Modern doctors believe that the causes of this disease include spleen deficiency,kidney deficiency,Yin(阴)deficiency,blood stasis,blood heat,etc.,which are related to women’s age,diet,ART process,and emotional state.In the treatment of this disease,there are many prescriptions for reference,such as Shoutai Wan(寿胎丸),Antai Yin(安胎饮),the Sijunzi decoction(四君子汤),the Siwu decoction(四物汤),etc.In clinical practice,drugs such as tonifying the kidney,promoting blood circulation and removing blood stasis,and strengthening the spleen are often used.High frequency matched drugs include Tusizi(Cuscuta chinensis)-Sangjisheng(Ramulus Taxilli)-Xuduan(Radix Dipsaci),Huangqin(Scutellaria baicalensis)-Baizhu(Atractylodes macrocephala Koidz.),Tusizi-Fupenzi(Rubus idaeus Linn),etc.In the clinical process,modern physicians have treated patients based on syndrome differentiation,flexibly cut ancient prescriptions,or added products of foetus protection,or combined with Western medicines such as dydrogesterone and heparin,with good results.Some doctors,based on their actual clinical experience,have developed their own formula for protecting the fetus and implemented individualized treatment,achieving remarkable therapeutic effects.The mechanism of TCM in treating this disease has not been fully studied.Existing studies have shown that TCM can help to improve microcirculation,promote the repair of fallopian tube

关 键 词：绒毛膜下血肿 胎动不安 中医药 研究进展 

分 类 号：R271[医药卫生—中医妇科学]