化瘀止血方治疗流产后子宫出血不净（血瘀证）的临床观察
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摘要
目的：观察化瘀止血方治疗流产后子宫出血不净(血瘀证)的疗效性和安全性。
方法：
1.临床资料所选病例均来源于2008年10月-2009年12月因流产后子宫出血不净在湖北省中医院门诊就诊,符合西医诊断为子宫复旧不良,中医辨证为血瘀证的患者48例,随机分为化瘀止血方治疗组(32例)和加味生化颗粒对照组(16例)。两组在年龄、病程、治疗前中医证侯积分及病情分级等方面经统计学分析,无显著差异性(p>0.05),具有可比性。
2.药物用法治疗组：化瘀止血方(免煎颗粒),每日一剂,分三次冲服。对照组：加味生化颗粒,每日3次,每次一袋,冲服。治疗期间均停用其他治疗流产后子宫出血不净的药物及可能影响观察结果的药物。
3.疗效及安全性观测两组患者在治疗前1天及用药结束后3天内分别进行中医证候评分和综合疗效评分。治疗前与治疗结束后分别做血常规、尿常规、肝肾功能(ALT、BUN、Cr)、EKG检查。
4.统计方法采用SPSS. V13.0软件辅助处理,计量资料用t检验,计数资料用χ2检验,等级资料采用Ridit分析.
结果：
1.临床综合疗效评定比较：治疗组总有效率90.625%,对照组总有效率87.500%。治疗后,两组综合疗效比较,p>0.05,无显著差异。
2.中医证候疗效比较：治疗组愈显率84.375%,总有效率90.625%,对照组愈显率81.250%,总有效率87.500%。
3.中医证候积分比较：治疗前后证候总积分变化组内比较,均p<0.05,有显著差异,治疗前后证候总积分变化组间比较均p>0.05,无显著差异。
4.止血疗效比较：两组患者治疗后止血疗效比较,p>0.05,无显著差异。
5.两组治疗前后子宫三径情况比较：两组治疗前后组内子宫三径比较,p<0.05,有显著差异,而组间治疗前后子宫三径比较无显著差异p>0.05。
6.不良反应及毒副作用比较：治疗组治疗前后安全性指标比较无显著性差异,两组在临床试验期间,均未出现明显不良反应及毒副作用。
结论：
化瘀止血方能有效治疗血瘀证流产后子宫出血不净,能帮助子宫复旧,明显改善流产后恶露持续时间及相关症状,临床应用安全有效,有较好的临床应用前景。
Objective
Treatment of stasis to stop bleeding after abortion bleeding does not net (blood stasis) of the efficacy and safety.
Methods
1. Clinical cases were selected from October 2008-2009 years in December in line with Western medicine clinic in our hospital was diagnosed as uterine involution bad, medicine blood stasis is not the net after abortion bleeding in patients with the diagnosis of 48 cases were randomly divided Blood hemostasis for the treatment group (32 cases) and Modified biochemical particle control group (16 cases). The two groups in age, duration, TCM Hou score, disease classification and so on through statistical analysis, no significant difference (p> 0.05), comparable.
2. Drug use treatment group:Blood hemostasis side (to avoid fried grain), one dose a day, three times a Chongfu. Control group: Modified biochemical particles, three times a day, every bag. Out during treatment were no other treatment of uterine bleeding after abortion drug and the net result may affect the observed drug.
3. Efficacy and safety of observing two groups of patients before Treatment one day, and three days after treatment score and comprehensive TCM efficacy score. Before and after treatment so routine, urine routine, liver and kidney function (ALT, BUN, Cr), EKG examination.
4. Statistical Methods SPSS.V13.0 auxiliary processing software, using t test measurement data, count data using X2 test, using Ridit level data analysis.
Results:
1. Comprehensive comparison of clinical efficacy evaluation:The total effective 90.625%, control group was 87.5%. After treatment, more comprehensive effect, p> 0.05, no significant difference.
2. TCM after the points to determine efficacy of comparison:the treatment group markedly effective rate of 84.375%, the total effective rate was 90.625%, markedly effective rate of 81.25% in control group, the total effective rate was 87.5%.
3. The total symptom score comparison:before and after treatment comparison group, both p<0.05, statistically significant changes after treatment, symptom total score between the two groups were p> 0.05, not significant.
4. Comparison of hemostatic efficacy:Hemostatic efficacy of the two groups were compared after treatment, p> 0.05, no significant difference.
5. Uterus before and after treatment in both groups compared to the situation three tracks:two groups were compared before and after treatment of uterine three-path, p<0.05, significant difference between the groups before and after treatment of uterine three-path no significant difference p> 0.05.
6. Comparison of adverse reactions and side effects:treatment group before and after the safety index was no significant difference between treatment and control groups in the clinical trial period, no significant adverse reactions and side effects.
Conclusion:Blood stasis to stop bleeding to effectively treat uterine bleeding after abortion is not the net, can help uterine involution, lochia significantly improved the duration of post-abortion and related symptoms, the clinical application of safe and effective and has good prospect for clinical application.
方法：
1.临床资料所选病例均来源于2008年10月-2009年12月因流产后子宫出血不净在湖北省中医院门诊就诊,符合西医诊断为子宫复旧不良,中医辨证为血瘀证的患者48例,随机分为化瘀止血方治疗组(32例)和加味生化颗粒对照组(16例)。两组在年龄、病程、治疗前中医证侯积分及病情分级等方面经统计学分析,无显著差异性(p>0.05),具有可比性。
2.药物用法治疗组：化瘀止血方(免煎颗粒),每日一剂,分三次冲服。对照组：加味生化颗粒,每日3次,每次一袋,冲服。治疗期间均停用其他治疗流产后子宫出血不净的药物及可能影响观察结果的药物。
3.疗效及安全性观测两组患者在治疗前1天及用药结束后3天内分别进行中医证候评分和综合疗效评分。治疗前与治疗结束后分别做血常规、尿常规、肝肾功能(ALT、BUN、Cr)、EKG检查。
4.统计方法采用SPSS. V13.0软件辅助处理,计量资料用t检验,计数资料用χ2检验,等级资料采用Ridit分析.
结果：
1.临床综合疗效评定比较：治疗组总有效率90.625%,对照组总有效率87.500%。治疗后,两组综合疗效比较,p>0.05,无显著差异。
2.中医证候疗效比较：治疗组愈显率84.375%,总有效率90.625%,对照组愈显率81.250%,总有效率87.500%。
3.中医证候积分比较：治疗前后证候总积分变化组内比较,均p<0.05,有显著差异,治疗前后证候总积分变化组间比较均p>0.05,无显著差异。
4.止血疗效比较：两组患者治疗后止血疗效比较,p>0.05,无显著差异。
5.两组治疗前后子宫三径情况比较：两组治疗前后组内子宫三径比较,p<0.05,有显著差异,而组间治疗前后子宫三径比较无显著差异p>0.05。
6.不良反应及毒副作用比较：治疗组治疗前后安全性指标比较无显著性差异,两组在临床试验期间,均未出现明显不良反应及毒副作用。
结论：
化瘀止血方能有效治疗血瘀证流产后子宫出血不净,能帮助子宫复旧,明显改善流产后恶露持续时间及相关症状,临床应用安全有效,有较好的临床应用前景。
Objective
Treatment of stasis to stop bleeding after abortion bleeding does not net (blood stasis) of the efficacy and safety.
Methods
1. Clinical cases were selected from October 2008-2009 years in December in line with Western medicine clinic in our hospital was diagnosed as uterine involution bad, medicine blood stasis is not the net after abortion bleeding in patients with the diagnosis of 48 cases were randomly divided Blood hemostasis for the treatment group (32 cases) and Modified biochemical particle control group (16 cases). The two groups in age, duration, TCM Hou score, disease classification and so on through statistical analysis, no significant difference (p> 0.05), comparable.
2. Drug use treatment group:Blood hemostasis side (to avoid fried grain), one dose a day, three times a Chongfu. Control group: Modified biochemical particles, three times a day, every bag. Out during treatment were no other treatment of uterine bleeding after abortion drug and the net result may affect the observed drug.
3. Efficacy and safety of observing two groups of patients before Treatment one day, and three days after treatment score and comprehensive TCM efficacy score. Before and after treatment so routine, urine routine, liver and kidney function (ALT, BUN, Cr), EKG examination.
4. Statistical Methods SPSS.V13.0 auxiliary processing software, using t test measurement data, count data using X2 test, using Ridit level data analysis.
Results:
1. Comprehensive comparison of clinical efficacy evaluation:The total effective 90.625%, control group was 87.5%. After treatment, more comprehensive effect, p> 0.05, no significant difference.
2. TCM after the points to determine efficacy of comparison:the treatment group markedly effective rate of 84.375%, the total effective rate was 90.625%, markedly effective rate of 81.25% in control group, the total effective rate was 87.5%.
3. The total symptom score comparison:before and after treatment comparison group, both p<0.05, statistically significant changes after treatment, symptom total score between the two groups were p> 0.05, not significant.
4. Comparison of hemostatic efficacy:Hemostatic efficacy of the two groups were compared after treatment, p> 0.05, no significant difference.
5. Uterus before and after treatment in both groups compared to the situation three tracks:two groups were compared before and after treatment of uterine three-path, p<0.05, significant difference between the groups before and after treatment of uterine three-path no significant difference p> 0.05.
6. Comparison of adverse reactions and side effects:treatment group before and after the safety index was no significant difference between treatment and control groups in the clinical trial period, no significant adverse reactions and side effects.
Conclusion:Blood stasis to stop bleeding to effectively treat uterine bleeding after abortion is not the net, can help uterine involution, lochia significantly improved the duration of post-abortion and related symptoms, the clinical application of safe and effective and has good prospect for clinical application.
引文
[1]叶寒. 紧急避孕的研究现状与发展方向[J]. 中国妇幼保健,2001,16(2)：119～211.
[2]赵萍.中西医结合治疗流产后出血34例.中国中医药现代远程教育,2005; 6 (2)： 30.
[3]陈纪藩.金医要略[M].北京：人民卫生出版社,2000：680.
[4]隋.巢元方.诸病源候论[M].北京：人民卫生出版社,1995：259.
[5]清.程钟龄.医学心悟[M].北京：人民卫生出版社,1995：125.
[6]北京中医学院.内经释义[M].上海：上海科学技术出版社,1985：295.
[7]黄丽丽.米非司酮抗早孕时蜕膜纤溶酶原激活剂及其抑制物mRNA和蛋白表达研究[J].中国计划生育学杂志,2002,10：598-599.
[8]许梅芬,金毓翠,岑幻仙,等.药物流产后子宫刮出物的组织学观察[J].中华妇产科杂志,1994,29(12)：739.
[9]张金玉.米非司酮配伍米索前列醇终止早孕出血原因的研究[J].中国适用妇科与产科杂志,1999,15(3)：159.
[10]贺昌海,范倩,顾江,等.米非司酮对早孕妇女血凝—纤溶系统的影响[J].生殖与避孕,1993(6)：429-435.
[11]莫凌昭.药物完全流产后阴道出血原因分析[J].华夏医学,1999,2(12)：197.
[12]杨铁虹,商澎,梅其炳.当归多糖硫酸酯对凝血和血小板聚集的作用[J].中草药,2002,33(11)：1010-1013.
[13]张晓君,祝晨陈,胡黎.当归多糖的免疫活性和对造血功能影响[J].中药药理与临床,2002,18(5)：24-25.
[14]刘斌,陆蕴如,孙建宁.蒲黄不同炮制品药理活性的比较研究[J].中成药,1998,20(3)：25
[15]刘文粢,黄爱东,罗丽卿,等.蒲黄及其炮制品15种元素的含量测量[J]广东微量元素科学,2003,10(1)：55-56
[16]吴皓,等.中国中药杂志,1993,18(3)：147
[17]高增平等,绵马贯众有效成分的研究[J]中国中药杂志；2003,12(3)：117
[18]贺玉琢.甘草的成分研究[J].国外医学中医中药分册,1995；17(4)：36-37
[1]张帝开.米非司酮合并丙酸睾丸酮配伍米索前列醇抗早孕研究实用妇产科杂志.1995；3(1)1：38
[2]杨明明,童建孙,王秀瑛,等1米非司酮抗早孕效果和可接受性研究.生殖与避孕1992；12(5)：73
[3]龚长武.浅谈药物流产后阴道出血的辩证施治[J].现代中医药,2002(3)： 34-35
[4]许梅芬,岑幻仙等.药物流产后子宫刮出物的组织学观察[J].中华妇产科杂志,1994,29(12)：739
[5]张金玉.米非司酮配伍米索前列醇终止早孕妇女血凝-纤溶系统的影响[J].中国实用妇科与产科杂志.1999,15(3)：159
[6]王学瑞.中药治疗药物流产后出血的疗效观察[J].中医杂志,1993,8 (34)：491
[7]张秀芬,周晴,章晓梅.中药辅助抗早孕268例疗效观察[J].云南中医杂志,1994,6 (15)：3
[8]徐杰.桃红四物汤治疗采用药物流产而无先兆流产40例小结[J].湖南中医杂志,1998,14(4)：451
[9]郑忠君.八珍冲剂治疗人工流产后出血120例[J].实用中医药杂志,2002,18 (1)：251.
[1 0]施燕.加味丹栀逍遥散治疗流产后出血200例[J].实用中医药杂志,2004, (26)：29.
[11]谢鸣,赵荣胜,卞宜心,等.中药辅助米非司酮终止早孕的疗效观察.中华妇产科杂志1996；31(6)：373
[12]刘宇新.清宫冲剂防治药流后恶露不绝.辽宁中医杂志1998；25(5)：216
[13]郑洪斌.益康止血冲剂的研究及临床应用.北京中医1996；15(3)：31
[14]关淑惠,南秀牌,李伟平,李立梅,诸益扬.桂枝茯苓胶囊用于治疗药物流产后阴道出血的临床观察[J].中国计划生育学杂志,2004,101 (3)：174-175.
[15]贺燕.宫太妇月康胶囊预防流产后出血的效果观察[J].现代中医药,2006,5(26)：23-24.
[16]陈林霞.生化汤治疗药物流产术后出血75例疗效观察[J].江西中医药,2003,2(2)：391
[17]戴青海,王连欣.产后生化汤治疗药物流产后阴道出血[J].云南中医中药杂志,1996,17(1)：26.
[18]周瑛,鲁豫静,宋永丽,人工周期疗法治疗早孕药物流产后阴道流血60例分析[J].中华实用中西医杂志,2002,2(15)：1503～1504.
[19]赵金华.应用催产素及宫血宁减少药物流产后阴道流血的临床观察[J].实用医技杂志,2005,12(4)：902-903.
[20]田洪兰,曾桂凤,李漪萍.小剂量已烯雌酚治疗药物流产后出血的临床观察[J].中国综合临床,2001,17(6)：471-472.
[21]南淑玲.甲基睾丸素治疗药物流产后阴道出血66例分析[J].海南医学,2005,1(5)：99.
[22]赵萍.中西医结合治疗流产后出血34例.中国中医药现代远程教育,2005： 6 (2)： 30.
[23]吴兴凤.中西医结合防治药物流产后阴道出血1 500例分析[J].武警医学,2000,11(4)：213-214.
[24]杜侠.中西医结合治疗人工流产术后阴道流血2200例.甘肃中医,2007;2 0(5)：47-48.
[2]赵萍.中西医结合治疗流产后出血34例.中国中医药现代远程教育,2005; 6 (2)： 30.
[3]陈纪藩.金医要略[M].北京：人民卫生出版社,2000：680.
[4]隋.巢元方.诸病源候论[M].北京：人民卫生出版社,1995：259.
[5]清.程钟龄.医学心悟[M].北京：人民卫生出版社,1995：125.
[6]北京中医学院.内经释义[M].上海：上海科学技术出版社,1985：295.
[7]黄丽丽.米非司酮抗早孕时蜕膜纤溶酶原激活剂及其抑制物mRNA和蛋白表达研究[J].中国计划生育学杂志,2002,10：598-599.
[8]许梅芬,金毓翠,岑幻仙,等.药物流产后子宫刮出物的组织学观察[J].中华妇产科杂志,1994,29(12)：739.
[9]张金玉.米非司酮配伍米索前列醇终止早孕出血原因的研究[J].中国适用妇科与产科杂志,1999,15(3)：159.
[10]贺昌海,范倩,顾江,等.米非司酮对早孕妇女血凝—纤溶系统的影响[J].生殖与避孕,1993(6)：429-435.
[11]莫凌昭.药物完全流产后阴道出血原因分析[J].华夏医学,1999,2(12)：197.
[12]杨铁虹,商澎,梅其炳.当归多糖硫酸酯对凝血和血小板聚集的作用[J].中草药,2002,33(11)：1010-1013.
[13]张晓君,祝晨陈,胡黎.当归多糖的免疫活性和对造血功能影响[J].中药药理与临床,2002,18(5)：24-25.
[14]刘斌,陆蕴如,孙建宁.蒲黄不同炮制品药理活性的比较研究[J].中成药,1998,20(3)：25
[15]刘文粢,黄爱东,罗丽卿,等.蒲黄及其炮制品15种元素的含量测量[J]广东微量元素科学,2003,10(1)：55-56
[16]吴皓,等.中国中药杂志,1993,18(3)：147
[17]高增平等,绵马贯众有效成分的研究[J]中国中药杂志；2003,12(3)：117
[18]贺玉琢.甘草的成分研究[J].国外医学中医中药分册,1995；17(4)：36-37
[1]张帝开.米非司酮合并丙酸睾丸酮配伍米索前列醇抗早孕研究实用妇产科杂志.1995；3(1)1：38
[2]杨明明,童建孙,王秀瑛,等1米非司酮抗早孕效果和可接受性研究.生殖与避孕1992；12(5)：73
[3]龚长武.浅谈药物流产后阴道出血的辩证施治[J].现代中医药,2002(3)： 34-35
[4]许梅芬,岑幻仙等.药物流产后子宫刮出物的组织学观察[J].中华妇产科杂志,1994,29(12)：739
[5]张金玉.米非司酮配伍米索前列醇终止早孕妇女血凝-纤溶系统的影响[J].中国实用妇科与产科杂志.1999,15(3)：159
[6]王学瑞.中药治疗药物流产后出血的疗效观察[J].中医杂志,1993,8 (34)：491
[7]张秀芬,周晴,章晓梅.中药辅助抗早孕268例疗效观察[J].云南中医杂志,1994,6 (15)：3
[8]徐杰.桃红四物汤治疗采用药物流产而无先兆流产40例小结[J].湖南中医杂志,1998,14(4)：451
[9]郑忠君.八珍冲剂治疗人工流产后出血120例[J].实用中医药杂志,2002,18 (1)：251.
[1 0]施燕.加味丹栀逍遥散治疗流产后出血200例[J].实用中医药杂志,2004, (26)：29.
[11]谢鸣,赵荣胜,卞宜心,等.中药辅助米非司酮终止早孕的疗效观察.中华妇产科杂志1996；31(6)：373
[12]刘宇新.清宫冲剂防治药流后恶露不绝.辽宁中医杂志1998；25(5)：216
[13]郑洪斌.益康止血冲剂的研究及临床应用.北京中医1996；15(3)：31
[14]关淑惠,南秀牌,李伟平,李立梅,诸益扬.桂枝茯苓胶囊用于治疗药物流产后阴道出血的临床观察[J].中国计划生育学杂志,2004,101 (3)：174-175.
[15]贺燕.宫太妇月康胶囊预防流产后出血的效果观察[J].现代中医药,2006,5(26)：23-24.
[16]陈林霞.生化汤治疗药物流产术后出血75例疗效观察[J].江西中医药,2003,2(2)：391
[17]戴青海,王连欣.产后生化汤治疗药物流产后阴道出血[J].云南中医中药杂志,1996,17(1)：26.
[18]周瑛,鲁豫静,宋永丽,人工周期疗法治疗早孕药物流产后阴道流血60例分析[J].中华实用中西医杂志,2002,2(15)：1503～1504.
[19]赵金华.应用催产素及宫血宁减少药物流产后阴道流血的临床观察[J].实用医技杂志,2005,12(4)：902-903.
[20]田洪兰,曾桂凤,李漪萍.小剂量已烯雌酚治疗药物流产后出血的临床观察[J].中国综合临床,2001,17(6)：471-472.
[21]南淑玲.甲基睾丸素治疗药物流产后阴道出血66例分析[J].海南医学,2005,1(5)：99.
[22]赵萍.中西医结合治疗流产后出血34例.中国中医药现代远程教育,2005： 6 (2)： 30.
[23]吴兴凤.中西医结合防治药物流产后阴道出血1 500例分析[J].武警医学,2000,11(4)：213-214.
[24]杜侠.中西医结合治疗人工流产术后阴道流血2200例.甘肃中医,2007;2 0(5)：47-48.
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