“通元针法”联合精玉药灸治疗肾虚血瘀型反复种植失败疗效观察  

Observation of the therapeutic effect of Tongyuan needling combined with jingyu herb-separated moxibustion on recurrent implantation failure of kidney deficiency and blood stasis

作　　者：兰柔 刘韵韵 肖秋凯 李月梅 LAN Rou;LIU Yun-yun;XIAO Qiu-kai;LI Yue-mei(First Clinical College of Guangzhou University of CM,Guangzhou 510405,Guangdong Province,China;Department of Rehabilitation of TCM,Eighth People's Hospital of Guangzhou,Guangzhou 510405,Guangdong Province)

机构地区：[1]广州中医药大学第一临床医学院,广东广州510405 [2]广州市第八人民医院中医康复科,广东广州510405

出　　处：《中国针灸》2023年第12期1405-1410,共6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:在常规激素替代周期方案行冻融胚胎移植基础上,观察“通元针法”联合精玉药灸治疗肾虚血瘀型反复种植失败(RIF)患者的临床疗效。方法:将60例拟行冻融胚胎移植的肾虚血瘀型RIF患者随机分为联合治疗组(30例)和西药组(30例)。西药组在移植周期采用常规激素替代方案进行子宫内膜准备;在西药组治疗基础上,联合治疗组采用“通元针法”加精玉药灸治疗,“通元针法”取“通督调神”A组穴位(大椎、肝俞、肾俞等督脉腧穴及背俞穴为主)及“引气归元”B组穴位(中脘、气海、关元等任脉腧穴及腹募穴为主),两组穴位交替针刺,每次取一组穴位,于针刺后隔药灸神阙穴(药粉由养精种玉汤方化裁调配而成),隔日1次,每周治疗3次,至移植日。比较两组患者妊娠结局指标[人绒毛膜促性腺激素(β-HCG)阳性率、临床妊娠率],以及治疗前后两组患者中医证候评分、血清雌二醇(E2)及孕酮(P)含量、子宫内膜厚度及类型、子宫内膜血流指数[搏动指数(PI)及阻力指数(RI)]。结果:治疗后,联合治疗组临床妊娠率为40.0%(12/30),高于西药组的16.7%(5/30,P<0.05);两组患者β-HCG阳性率比较差异无统计学意义(P>0.05)。治疗后,两组患者血清E2、P含量较治疗前升高(P<0.05),子宫内膜厚度较治疗前增加(P<0.05),中医证候评分、PI、RI较治疗前降低(P<0.05);联合治疗组A型内膜比例较治疗前升高(P<0.05)。除E2、P含量外,联合治疗组以上指标均优于西药组(P<0.05)。结论:在常规激素替代周期方案行冻融胚胎移植基础上,“通元针法”联合精玉药灸治疗可以有效改善肾虚血瘀型RIF患者临床症状,增加子宫内膜血流及子宫内膜厚度,提高子宫内膜容受性,从而改善妊娠结局。Objective To observe the therapeutic effect of Tongyuan needling combined with jingyu herb-separated moxibustion on the patients with recurrent implantation failure(RIF)of kidney deficiency and blood stasis undergoing frozen embryo transfer of the conventional hormone replacement therapy cycle.Methods Sixty RIF of kidney deficiency and blood stasis patients who planned for frozen embryo transfer were randomly divided into a combined treatment group(30 cases)and a western medication group(30 cases).In the western medication group,the conventional hormone replacement therapy was performed for endometrial preparation during transfer cycle.On the basis of treatment as the western medication group,in the combined treatment group,Tongyuan needling combined with jingyu herb-separated moxibustion was adopted.Regarding tongyuan needling,the acupoint prescription for Tongdu Tiaoshen(promoting the governor vessel and regulating the spirit,e.g.Dazhui[GV 14],Ganshu[BL 18],Shenshu[BL 23]and back-shu points)and that for Yinqi Guiguan(conducting qi back to the primary,e.g.Zhongwan[CV 12],Qihai[CV 6],Guanyuan[CV 4]and front-mu points)were selected.Acupuncture was delivered at these two prescriptions alternatively each time.After acupuncture,the herb-separated moxibustion(in which,the herbal powder was prepared with the modified Yangjing Zhongyu decoction for cultivating the kidney essence and promoting pregnancy)was operated at Shenque(CV 8).This combined therapy was delivered once every two days,3 sessions a week till the day of embryo transfer.The pregnancy outcomes(positive rate of human chorionic gonadotropin[β-HCG]and clinical pregnancy rate)were compared between the two groups,as well as the TCM syndrome score,serum estradiol(E2)and progesterone(P)levels,endometrial thickness and type,endometrial blood flow index(pulsatility index[PI],resistance index[RI])before and after treatment.Results After treatment,the clinical pregnancy rate of the combined treatment group was 40.0%(12/30),higher than that of the western medication

关 键 词：反复种植失败 肾虚血瘀型 通元针法 隔药灸 子宫内膜容受性 妊娠率 随机对照试验 

分 类 号：R246.3[医药卫生—针灸推拿学]