摘要
背景
人工终止妊娠术依照方法可以分为药物流产术和人工流产术。人工流产术是指妊娠14周以内,因疾病、防止先天性畸形儿出生、遗传病及非法妊娠等原因而采用的人工终止妊娠手术。人工流产术是目前国内外妇产科医生最普遍采用的终止早孕的方法,也是非意愿妊娠女性最常选择的终止妊娠方式。因国家实施计划生育政策,同时随着改革开放及经济发展,人们性观念日益开放,未婚先孕及已婚再孕的人群日益增多。有文章报道,中国每年有一千万非意愿妊娠的妇女选择流产,在已婚育的妇女中,98%非意愿妊娠者选择人工流产。在我国由于受文化背景、社会行为规范和法律道德的影响,未婚先孕的女性也多以人工流产为结局。然而,人工流产手术后各种不适症状以及其远期并发症所造成的身心健康伤害,务必引起医学界的关注。人工流产手术给患者带来种种不适症状,调摄不当则有可能继发各种远期并发症,这一状况符合现代医学亚健康的诊断。
龚海洋等认为：亚健康状态是指人的身心处于疾病与健康之间的一种低质状态,机体虽无明确的疾病,但在躯体上、心理上出现种种不适应的感觉和症状,它既可继续发展为疾病,也可经自身调节或治疗而恢复健康。现代社会中,女性社会地位在提高,家庭生活与工作负担却在加重,特别是人工流产术后很多女性忽视了必要的调摄,女性亚健康状态也成为时代的产物。因为如调摄不当,在这种状态之后很可能发生的即是所谓的人工流产远期并发症,吴英杰认为主要包括：月经失调甚至闭经、子宫内膜炎、盆腔炎及输卵管炎、子宫颈管及宫腔粘连、盆腔子宫内膜异位症、继发性不孕、再次妊娠晚期流产率及早产率增高、异位妊娠的发病率增高等。
中医疗法如口服中药、针刺、灸法等传统疗法在预防和治疗人工流产术后导致的远期并发症有着很好疗效。近年来,中医传统新兴的砭术综合疗法在治疗妇科疾病方面也取得卓效。
目的
穴位、经络和脏腑有着密切的联系,而施氏砭术综合疗法采用砭石刮法刺激经络、针刺穴位配合砭石温熨,使机体建立新的平衡,远离亚健康状态。临床上已有用施氏砭术综合疗法治疗妇科慢性盆腔疼痛,取得一定效果的报道。本项目针对人工流产术后女性这一特殊时期常表现出来的躯体、心理、精神等方面的不适状态或机体适应能力的降低状态,提出了“人工流产术后女性亚健康状态”这一概念,采用前瞻性、临床随机对照研究方法,通过观察和分析施氏砭术综合疗法治疗人工流产术后肾虚血瘀型亚健康状态及其对术后心理亚健康状态患者疗效及治疗优势。为临床治疗人工流产术后女性亚健康状态提供新型有效的治疗方式,探讨并制定完善有效施氏砭术综合疗法方案和临床操作规范,有利于临床推广并应用。
方法
采用随机、对照的方法,选择2010年3月-2011年3月至广东省中医院妇科门诊就诊,随机纳入符合纳入标准的患者,分为治疗组(71例)和对照组(70例)。治疗组的患者人工流产术后除常规给予抗生素预防感染外,还实施施氏砭术综合疗法；对照组只给予抗生素预防感染治疗。采用人工流产术后亚健康症状评分,并结合多项指标对两种治疗方式进行临床观察,最后将相关数据输入Epideta,建立数据库,并用统计软件SPSS13.0进行统计分析。
结果
1.治疗组71例,人工流产术后3天阴道出血总量多于月经量者占4.2%,等于月经量者占28.2%,少于月经量者占67.6%,术后阴道出血时间最短为2天,最长为7天；对照组70例,多于月经量者占12.9%,等于月经量者占50%,少于月经量者占37.1%,术后阴道出血时间最短为3天,最长为9天。两者相比较,均有统计学差异(P<0.05),说明施氏砭术综合疗法减少人工流产术后阴道持续出血时间及术后阴道出血量的效果优于对照组。
2.两组人工流产术后患者月经的首次复潮时间,治疗组平均为32.40±3.85天,对照组平均为36.14±5.51天,两者相比较,有显著差异(p<0.01),说明人工流产术后实施施氏砭术综合疗法,有助于机体下丘脑-垂体-卵巢轴内分泌恢复。
3.在纳入研究141例患者人工流产术前3个月月经周期均正常,两组术后第2月、第3月月经自然复潮均是70例。治疗组术后第2月月经周期为30.99±3.00天,术后第3月月经周期为31.47±3.22天；对照组术后第二月月经周期为32.07±3.66天,术后第3月月经周期为32.90±3.78天,将两组人工流产术后第2月、第3月月经周期分别进行比较,均有统计学差异(P 4.对治疗组与对照组人工流产术后首次月经复潮伴围经期不适症状发生数量进行比较,差异有统计学意义(P<0.05),提示施氏砭术综合疗法有助于减少人工流产术后首次月经复潮围经期不适症状发生。
5.两组人工流产术后2周、1个月躯体、心理亚健康症状评分分别相比较,均有统计学差异(P<0.05),表明人工流产术后实施施氏砭术综合疗法能够改善患者术后躯体、心理亚健康状态,‘尽快消除患者术后不适身心症状,提高患者生存质量。
6.对照组人工流产术后2周、1个月躯体亚健康评分比较,无统计学意义(P>0.05),治疗组人工流产术后2周和术后1月躯体、心理亚健康症状评分各自比较,有显著统计学差异(P<0.01),说明人工流产术后实施施氏砭术综合疗法1个月治疗的患者在心理、躯体亚健康方面改善效果优于术后实施施氏砭术综合疗法2周治疗的患者。提示随着治疗次数的增多,改善术后患者心理、躯体亚健康状态愈明显,而无任何干预治疗措施下人工流产术后患者躯体不适症状将会长时间持续。
7.比较两组治疗后患者疗效自评,分为痊愈、有效、好转、无效四个等级。治疗组71人,痊愈42例,显效21例,有效3例,无效5例,总有效率93%；对照组70例,痊愈30例,有效20例,好转10例,无效10例,总有效率85.7%。两组疗效自评等级比较,有统计学差异(P<0.05),说明治疗组疗效自评优于对照组。
结论
施氏砭术综合疗法能减少人工流产术后患者阴道出血的时间和阴道出血量,调整术后月经复潮时间,有助于术后建立规律月经周期,减少人工流产术后患者月经复潮围经期不适症状发生,改善术后患者心理、躯体亚健康状态,提高患者术后生存质量,有助于减少人工流产术远期并发症的发生。
Background of theory
In accordance with the method to abort a pregnancy can be divided into intraoperative intraoperative and abortion drug abortion resection. Abortion refers to the operation within 14 weeks gestation, because of the disease, prevent congenital oaf was born, genetic diseases and illegal pregnancy etc. Reason to abort a pregnancy with surgical. Abortion doctor at home and abroad art is the most widely used obstetrics and gynecology terminate pregnancies methods, and is an unwanted pregnancy women most often choose way the termination of pregnancy. For the country's family planning policy, at the same time with the opening and reform and economic development, people increasingly open and sexual attitudes premarital pregnancy and married again pregnant increased. The crowd An article reports, China each year million of unwanted pregnancy, women who choose to abortion in women have baby,98% of unwanted pregnancy choose abortion. In our country, due to culture, social behavior standard and the influence of legal morality, the women also premarital pregnancy in abortion as a final outcome. However, abortion and various symptoms after surgery complications caused by the long-term health of body and mind, be sure to cause damage the medical attention. Artificial abortion to bring a variety of symptoms, patients with improper cultivate may have long-term complications of secondary to that situation conform to the diagnosis of modern medical and health.
GongHaiyang etc think:subhealthy state refers to human body and mind in a disease and the health of a kind of low-quality state, the body is no specific disease, but in the body, psychological appeared various does not adapt the feeling and symptoms, it can be continued development for disease, also can adjust or treatment by itself back to health. In modern society, in improving their social status, family life and work, especially in aggravate burden but abortion postoperative many women ignored the necessary cultivate, female subhealth state has become the product of the era. Because, as cultivate undeserved, in this state that what happened next is the so-called abortion long-dated complications, WuYingjie think mainly includes:menstrual disorders and even amenorrhoea, endometritis, pelvic inflammation and tubal phlogistic, uterine cervix tube and adhesion, pelvic endometriosis, secondary to infertility, pregnancy again late spontaneous abortion rate and preterm rate rising and incidence of ectopic pregnancy etc.
Chinese medicine therapy as oral traditional Chinese medicine, acupuncture and moxibustion therapy in traditional prevention and treatment of abortion in long-term complications after having very good curative effect, in recent years, Chinese traditional emerging Shi's stone needle art combination therapy in the treatment of gynecological disease also obtain effective cleansing.
objective
Acupuncture channels, meridians and viscera has the close relation, and performed by Shi's stone needle art combination therapy with acupuncture channels, stimulus stone needle temperature ironing, make the body to build new balance, away from the sub-health state clinically Shi's stone needle art combination therapy already useful intraoperative comprehensive therapy to cure gynecological chronic pelvic pain, obtained a certain result. This project aimed at abortion postoperative women this particular period show women are often the physical, psychological and spiritual state or aspects of discomfort body adaptive capacity, we put forward "reduce state induced abortion postoperative female subhealth state" this concept, using prospectie, randomized study method of clinical observation and analysis, through Shi's stone needle art combined therapy abortion postoperative kidney deficiency blood stasis syndrome of sub-health status and postoperative spirit and effect of depressed patients treatment of advantage. For clinical treatment abortion postoperative subhealth state to offer new effective treatment method to explore and develop Shi's stone needle art combined therapy perfect effective comprehensive therapy scheme and clinical operation norm, be helpful for clinical promotion and application.
methods
The method using randomized, selected by 2010, march-2011 March to guangdong province hospital of traditional Chinese medicine, gynecological clinic doctor, random into standard patients, divided into the treatment group (71 cases) and the control group (70 cases). The treatment group of patients after abortion in addition to convetion are given antibiotics to prevent infection, still Shi's stone needle combination therapy implementation; The control group given antibiotics only to prevent infection treatment. Using artificial abortion postoperative symptoms of sub-health, and with more index rating of two kinds of treatments for clinical observation and will establish relevant data input Epideta and statistical software SPSS13.0 database of statistical analysis.
Research results
1.71 cases in treatment group after 3 days, abortion vaginal bleeding amount more than the menstrual quantity of 4.2%, equal to the menstrual quantity of the menstrual quantity, less 28.2% of postoperative bleeding 67.6%, the shortest time for 2 days, the longest for 7 days; The control group, more than 70 cases of menstrual quantity, equal to the menstrual quantity to 12.9%, less than 50% of the menstrual quantity 37.1%, postoperative bleeding the shortest time for 3 days, the longest for 9 days. Both are compared, was statistical difference (P<0.05), indicating that Shi's stone needle comprehensive therapy to reduce abortions performed after vaginal bleeding time and vaginal bleeding continues the effect is better than the control group.
2. The two groups of abortion postoperative patients first after boom time menstruation, treatment group average for 32.40±3.85days, the control group for 36.14±5.51days on average, two groups significant difference compared compared(p<0.01), After that Shi's stone needle comprehensive therapy helps the body hypothalamus-pituitary-adrenal axis endocrine restore ovary.
3. To be included in the research of 141 patients abortion preoperative 3 months are normal menstrual cycle, two groups of postoperative the second month, the third month menstrual natural after tide are 70 cases. The treatment group at the postoperative second month menstrual cycles for 30.99±3.00 days, and postoperative third month for 31.47±3.22days menstrual cycle; The control group at the postoperative second month menstrual cycles for 32.07±3.66 days, and postoperative third month for 32.90±3.78 days menstrual cycle, two group of abortion in second month and third month menstrual cycle, all have statistically significant difference (P<0.05), Tip Shi's stone needle comprehensive therapy help abortion postoperative patients establish rules menstrual cycles.
4. The treatment group and control group for first time menstruation complex after abortion with premenstrual syndrome tide comparison, differences have number of statistical significance (P<0.05), Shi's stone needle comprehensive therapy intraoperative tips help reduce abortion first menstrual after tide postoperative symptoms occur surrounded period.
5. Two groups of abortion postoperative 2 weeks,1 month physical, mental sub-health symptom scores are compared respectively, statistical differences (P<0.05), shows that Shi's stone needle comprehensive therapy intraoperative can improve patients'physical, mental sub-health postoperative patients with state, eliminate as soon as possible after psychosomatic symptoms and improve their discomfort is quality of life.
6. After two weeks group abortion,1 month body and health score comparison, was not statistically significant (P>0.05), treatment after two weeks of abortion and postoperative one month physical, mental sub-health symptom scores a statistically significant comparative, their difference (P<0.01), indicating that Shi's stone needle comprehensive therapy 1 months of therapy in patients with mental, physical and health improvement effect is better than Shi's stone needle comprehensive therapy patients treated 2 weeks. Suggest that as the increase of treatment frequencies, improve postoperatively, psychological, and physical subhealth state the obvious, and any without intervention measures next abortion postoperative patients body unwell symptom duration will be President.
7. Compare two groups after treating patients, divided into self-evaluation curative effect whole, effective, improvement, invalid four ranks. The treatment group 71, healed 42 cases, powerfully 21 cases marked effectiveness, 3 cases effectiveness and 5 cases failure; the total effective 93%;The control group,30 patients recovered 70 cases, effective 20 cases,10 cases were better, 10 cases failure; the total effective invalid 85.7%. Two curative effect of self-evaluation level comparison, statistically significant (P<0.05), indicating that the curative effect of treatment group in the control group since recommendation.
Conclusion
Shi's stone needle comprehensive therapy can reduce artificial abortion postoperative patients vaginal bleeding time and vaginal bleeding, adjust the postoperative period after boom time, establish postoperative rule menstrual cycle, reduce artificial abortion postoperative patients menstrual period unwell symptom complex tide wai occur, improve postoperative patients psychological, physical and health condition and improve their quality of life, help reduce postoperative who performed abortions long-term complications.
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