滋肾填精汤治疗人工流产术后肾精亏虚型月经过少的临床疗效观察
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摘要
目的：通过本研究为滋肾填精法治疗人工流产术后肾精亏虚型月经过少患者提供临床依据,客观、真实的评价中医滋肾填精法治疗人流术后月经过少的疗效。
方法：本研究拟采用随机对照的临床试验设计方法,收集临床诊断为人流术后肾精亏虚型月经过少的患者45例,随机分入治疗组与对照组,其中治疗组30例予滋肾填精中药治疗,对照组15例予左归丸治疗。3个月为一个疗程,连续观察1个疗程,观察治疗前后的月经量的变化及伴随的相关证候的改变,并对治疗前后的B超(子宫动脉血流搏动指数PI、阻力指数R1及子宫内膜厚度)、激素水平(E2、FSH、LH)情况进行统计比较,评价滋肾填精法治疗人流术后肾精亏虚型月经过少的疗效。
结果：根据月经失调治疗标准评价疗效,治疗组与对照组均能改善患者临床表现,滋肾填精法治疗人工流产术后月经过少总有效率达83.33%,其中痊愈率6.67%,显效率30.00%,有效率46.67%,无效率16.67%。根据中医证候积分标准评价疗效,治疗组中医证侯积分差值明显大于对照组,经t检验差异显著(P<0.01),提示治疗组治疗后中医证侯改善作用明显优于对照组。两组对血清E2值、LH值、FSH值无明显影响(P>0.05)。治疗组与对照组均对子宫内膜厚度有影响,治疗前后内膜厚度具有可比性,且治疗组优于对照组(P<0.05)。两组患者治疗前后子宫动脉PI值无明显变化(P>0.05),无统计意义,但治疗后子宫动脉RI值较治疗前降低(P<0.05),提示两组均能提高子宫动脉血流速度,改善子宫灌注及微循环
结论：滋肾填精中药能增加人工流产术后肾精亏虚型月经过少忠者的月经量,滋养子宫内膜,促进子宫内膜生长,加速子宫动脉血液循环,改善忠者临床伴随症状,提高患者生活质量。
Objective:To provide clinical evidence for the treatment of essence type of Hypomenorrhea. Verity and objective appraisal the curative effect of nourishing kidney essence and blood method after the treatment of hypomenorrhea caused from abortion
Methods:This paper plan to use randomized controlled clinical trial design method. Use collected clinical diagnosis of45patients of hypomenorrhea were randomly divided into treatment and control groups. Select medicines for the30patients in the treatment group according to nourishing Kidney essence and blood method, and use Zuo Gui Pill for the15patients in the control groups. Set3months as a course of treatment, continuously observed the changes in menstrual blood volume and other simultaneous phenomenons. And compare the post-treatment data of B-mode Ultrasound(the blood flow pulse index(PI) of the uterine arteries and the blood flow resistance index(RI) of the uterine arteries; endometrial thickness and hormone level(E2, FSH, LH) with the pre-treatment data. Appraise the Efficacy of nourishing Kidney essence and blood method in the treatment of essential deficient blood deficiency type of hypomenorrhea.
Results:According to menstruation disturbances treatment standards, both methods can improve their clinical syndromes, the total effective rate of nourishing kidney essence and blood method can reach83.33%, with a cure rate of6.67%, obvious effective rate of30.00%and a effective rate of46.68%. The ineffective rate was16.67%. Use the rate of the evaluation of Chinese modi cine syndrome effect for estimating the curative, the difference of the Chinese medicine syndrome scores in the treatment group is larger than the control group(P<0.01), this suggesting that the treatment group was superior than the control group. Both of the two group has no effect to E2, LH and FSH. There is no significance to statistic if P>0.05. Both of the group has a effect to the endometrial thickness. If P<0.05, the treatment group is superior than the control group by inspection. The blood flow pulse index(Pl) of the uterine arteries in both group did not change obviously, as P>0.05there is no significance to statistic. But the blood flow resistance indcx(RI) of the uterine arteries in post-treatment is lower than in pre-treatment because P<0.05by inspection, suggesting that both group can increase the blood flow velocity in uterine artery, improve uterus perfusion and Microcirculation.
Conclusion:The Chinese Herbs nourishing kidney essence and blood can increase patients' scanty menstruation who has the the blood and essence asthenia kind of hypomenorrhea, nourishing endometrial, Promote the growth of endometrial, speed up blood stimulation in the endometrium, improve patient's clinical concomitant symptoms, enhance the patient's quality of life.
方法：本研究拟采用随机对照的临床试验设计方法,收集临床诊断为人流术后肾精亏虚型月经过少的患者45例,随机分入治疗组与对照组,其中治疗组30例予滋肾填精中药治疗,对照组15例予左归丸治疗。3个月为一个疗程,连续观察1个疗程,观察治疗前后的月经量的变化及伴随的相关证候的改变,并对治疗前后的B超(子宫动脉血流搏动指数PI、阻力指数R1及子宫内膜厚度)、激素水平(E2、FSH、LH)情况进行统计比较,评价滋肾填精法治疗人流术后肾精亏虚型月经过少的疗效。
结果：根据月经失调治疗标准评价疗效,治疗组与对照组均能改善患者临床表现,滋肾填精法治疗人工流产术后月经过少总有效率达83.33%,其中痊愈率6.67%,显效率30.00%,有效率46.67%,无效率16.67%。根据中医证候积分标准评价疗效,治疗组中医证侯积分差值明显大于对照组,经t检验差异显著(P<0.01),提示治疗组治疗后中医证侯改善作用明显优于对照组。两组对血清E2值、LH值、FSH值无明显影响(P>0.05)。治疗组与对照组均对子宫内膜厚度有影响,治疗前后内膜厚度具有可比性,且治疗组优于对照组(P<0.05)。两组患者治疗前后子宫动脉PI值无明显变化(P>0.05),无统计意义,但治疗后子宫动脉RI值较治疗前降低(P<0.05),提示两组均能提高子宫动脉血流速度,改善子宫灌注及微循环
结论：滋肾填精中药能增加人工流产术后肾精亏虚型月经过少忠者的月经量,滋养子宫内膜,促进子宫内膜生长,加速子宫动脉血液循环,改善忠者临床伴随症状,提高患者生活质量。
Objective:To provide clinical evidence for the treatment of essence type of Hypomenorrhea. Verity and objective appraisal the curative effect of nourishing kidney essence and blood method after the treatment of hypomenorrhea caused from abortion
Methods:This paper plan to use randomized controlled clinical trial design method. Use collected clinical diagnosis of45patients of hypomenorrhea were randomly divided into treatment and control groups. Select medicines for the30patients in the treatment group according to nourishing Kidney essence and blood method, and use Zuo Gui Pill for the15patients in the control groups. Set3months as a course of treatment, continuously observed the changes in menstrual blood volume and other simultaneous phenomenons. And compare the post-treatment data of B-mode Ultrasound(the blood flow pulse index(PI) of the uterine arteries and the blood flow resistance index(RI) of the uterine arteries; endometrial thickness and hormone level(E2, FSH, LH) with the pre-treatment data. Appraise the Efficacy of nourishing Kidney essence and blood method in the treatment of essential deficient blood deficiency type of hypomenorrhea.
Results:According to menstruation disturbances treatment standards, both methods can improve their clinical syndromes, the total effective rate of nourishing kidney essence and blood method can reach83.33%, with a cure rate of6.67%, obvious effective rate of30.00%and a effective rate of46.68%. The ineffective rate was16.67%. Use the rate of the evaluation of Chinese modi cine syndrome effect for estimating the curative, the difference of the Chinese medicine syndrome scores in the treatment group is larger than the control group(P<0.01), this suggesting that the treatment group was superior than the control group. Both of the two group has no effect to E2, LH and FSH. There is no significance to statistic if P>0.05. Both of the group has a effect to the endometrial thickness. If P<0.05, the treatment group is superior than the control group by inspection. The blood flow pulse index(Pl) of the uterine arteries in both group did not change obviously, as P>0.05there is no significance to statistic. But the blood flow resistance indcx(RI) of the uterine arteries in post-treatment is lower than in pre-treatment because P<0.05by inspection, suggesting that both group can increase the blood flow velocity in uterine artery, improve uterus perfusion and Microcirculation.
Conclusion:The Chinese Herbs nourishing kidney essence and blood can increase patients' scanty menstruation who has the the blood and essence asthenia kind of hypomenorrhea, nourishing endometrial, Promote the growth of endometrial, speed up blood stimulation in the endometrium, improve patient's clinical concomitant symptoms, enhance the patient's quality of life.
引文
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[5]刘新军.中西医结合治疗人流术后闭经35例[J].国医论坛,2004,19(6)：41-42.
[6]袁萍,蒋荣超.补肾益血汤治疗人流术詹月经量少58例[J].中国中医急症,2005,(9)：861.
[7]林寒梅.辨证治疗药物流产及人工流产后闭经及月经过少[J].广西中医药,2008,31(3)：26
[8]朱贵荣.夏阳主任医师辨治月经过少的用药经验陕西中医学院学报,2006,01(29)：18
[9]李伟莉,梁文珍.治疗子宫内膜损伤性月经过少经验[J].中医药临床杂志,2008,20(6)：554-555
[10]王雪敏，王芝敏.人流术后闭经的辨证治疗[J].河南中医,2001,21(4)：12-13
[11]王韵蕊，卓毅.加减滋水清肝饮治疗人工流产术后月经过少40铡[J].现代中西医结合杂志,2008,(7)：1044—1045。
[12]江伟华.补肾化瘀汤治疗人工流产后闭经98例[J].中医杂志,2003,44(2)：99
[13]唐厚秀,蔡秀莲.补肾活血法治疗人工流产术后月经过少症50例[B].现代中西医结合杂志；2010,19(26)
[14]郭艳,张玉.定经汤治疗月经过少30例的临床体会[J].贵阳中医学院学报.2011,2(33)：87-88
[15]丁红卫.二仙汤为主方中药周期疗法治疗月经量少40例[J].陕西中药2008,29(7)：807
[16]朱艳梅.中药周期疗法治疗肾虚血瘀型月经过少疗效观察[J]世界中西医结合杂.2009,4(3)：207.
[17]夏智.等.针灸配合中药治疗人工流产术后闭经60例疗效观察[J].中医中药,2009.47(27)：89
[18]刘美清.一贯煎配合针刺治疗继发性子宫型闭经26例[J].湖南中医杂忠,1997,13(15)：34
[19]刘媛媛等Clinical Study on Hydro-acupuncture for Hypomenorrhea, J. Acupunct. Tuina. Sci.2011,9 (5): 307-309
[20]乐爱文,袁瑞,等雌激素受体β基因多态性与原因不明月经过少的关系[J].中国科大学学报,2007,6(36)
[21]袁瑞,等.雌激素受体α基因TA重复序列多态性与原因不明月经过少的关系[J].重庆医科大学学报,2006,5(31)
[22]周晓曦,等.月经过少子宫内膜中基质金属蛋白酶及基质金属蛋白酶抑制物农达及意义[J].重庆医科大学学报,2007,8(32)
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