GnRH-a联合补肾祛瘀治疗EMT术后60例
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摘要
目的观察子宫内膜异位症术后运用GnRH-a联合补肾祛瘀方治疗的临床疗效及对GnRH-a的毒副反应的影响。方法采用随机数字表法将腹腔镜术后肾虚血瘀型EMT患者120例分为对照组和观察组各60例。2组均于术后月经来潮第1天开始皮下注射醋酸亮丙瑞林(GNRH-a)3.75 mg,每28 d 1针,共3针。观察组同时口服补肾祛瘀方,于每次注射GnRH-a的第1天起服用,每日1剂,服21 d为1个疗程,对照组仅注射GnRH-a。2组均治疗3个疗程,于注射第3针后第28天进行疗效评估,分析2组治疗前后肾虚、血瘀积分及分级情况、血管舒缩综合征发生情况以及E_2、FSH的变化。结果观察组治疗后肾虚评分及分级情况较治疗前降低(P<0.05),对照组较治疗前升高(P<0.05);2组治疗后血瘀评分与分级情况较治疗前均降低,且观察组低于对照组(P<0.05);观察组治疗后血管舒缩综合征症状出现情况及评分较对照组明显降低(P<0.05);2组治疗后E_2、FSH较治疗前明显下降(P<0.05),治疗后2组比较无统计学意义(P>0.05)。结论补肾祛瘀法防治EMT腹腔镜术后应用GnRH-a致血管舒缩综合征疗效肯定,其可不通过改变E_2、FSH水平而改善血管舒缩症状,增强患者对GnRH-a的耐受性,减少GnRH-a的毒副反应。
Objection: To observe the clinical effect of tonifying kidney and removing stasis method on GnRH-a induced vasomotor syndrome after EMT surgery. Methods: Divided patients with EMT laparoscopic postoperative syndrome featuring kidney deficiency and blood stasis into the experimental group and the control group, with 60 cases in each group. The experimental group was treated with tonifying kidney and removing stasis decoction, which was administered on the first day after the injection of GnRH-a, for a total of three courses of treatment. The control group was only injected with GnRH-a. Efficacy evaluation was conducted 28 days after the third injection. The scores and grading of kidney deficiency and blood stasis, the occurrence of vasomotor syndrome and the changes of E_2 and FSH were analyzed before and after treatment in the two groups. Results: Renal scores and grades in the experimental group were lower than those before treatment(P<0.05), while in the control group were higher than those before treatment(P<0.05). The blood stasis scores and grades of the two groups were lower than those before treatment, and the experimental group was lower than the control group(P<0.05). The number of cases and scores of vasomotor syndrome in the experimental group was lower than that in the control group after treatment(P<0.05). E_2 and FSH decreased in both groups after treatment compared with those before treatment(P<0.05), but there was no significant difference between the two groups(P<0.05). Conclusion: The method of tonifying kidney and removing stasis is effective in preventing and treating vasomotor syndrome induced by GnRH-a after EMT laparoscopic surgery. It does not improve vasomotor symptoms by changing the levels of E_2 and FSH, but can enhance the patient's tolerance to GnRH-a and reduce side effects.
Objection: To observe the clinical effect of tonifying kidney and removing stasis method on GnRH-a induced vasomotor syndrome after EMT surgery. Methods: Divided patients with EMT laparoscopic postoperative syndrome featuring kidney deficiency and blood stasis into the experimental group and the control group, with 60 cases in each group. The experimental group was treated with tonifying kidney and removing stasis decoction, which was administered on the first day after the injection of GnRH-a, for a total of three courses of treatment. The control group was only injected with GnRH-a. Efficacy evaluation was conducted 28 days after the third injection. The scores and grading of kidney deficiency and blood stasis, the occurrence of vasomotor syndrome and the changes of E_2 and FSH were analyzed before and after treatment in the two groups. Results: Renal scores and grades in the experimental group were lower than those before treatment(P<0.05), while in the control group were higher than those before treatment(P<0.05). The blood stasis scores and grades of the two groups were lower than those before treatment, and the experimental group was lower than the control group(P<0.05). The number of cases and scores of vasomotor syndrome in the experimental group was lower than that in the control group after treatment(P<0.05). E_2 and FSH decreased in both groups after treatment compared with those before treatment(P<0.05), but there was no significant difference between the two groups(P<0.05). Conclusion: The method of tonifying kidney and removing stasis is effective in preventing and treating vasomotor syndrome induced by GnRH-a after EMT laparoscopic surgery. It does not improve vasomotor symptoms by changing the levels of E_2 and FSH, but can enhance the patient's tolerance to GnRH-a and reduce side effects.
引文
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[2]中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症的诊治指南[S].中华妇产科杂志,2015,50(3):161-169.
[3]朱文锋.证素辨证学[M].北京:人民卫生出版社,2008:70-90,171-173.
[4]中国药学会药事管理专业委员会.中国医药卫生改革与发展相关文件汇编(2011-2012年度)[M].北京:中国医药科技出版社,2012:398-399.
[5]郑峥,林战.更年期综合症[M].广州:广州出版社,2003:12.
[6]谈勇.中医妇科学[M].4版.北京:中国中医药出版社,2016:276-278.
[7]王小红,李奕祺,郭晓黎,等.子宫内膜异位症患者周期性瘀血的临床研究[J].中华中医药杂志,2012,27(4):1152-1154.
[8]周艳,李强.补肾活血化瘀法联合腹腔镜手术治疗子宫内膜异位症的效果观察[J].中国医刊,2014,49(4):94-96.
[9]葛莉莉,叶春萍,余宁珠.腹腔镜手术联合促性腺激素释放激素激动剂治疗子宫内膜异位症的疗效及对患者生殖内分泌激素水平的影响[J].中国妇幼保健,2018,33(17):4056-4059.