【作者】 楼豪英；

【导师】 李坤寅；

【作者基本信息】 广州中医药大学 ， 中医妇科学， 2011， 硕士

【摘要】 [目的]在运脾饮治疗妇科术后诸症的前期研究基础之上,观察加减运脾饮促进剖宫产术后胃肠功能恢复、乳汁分泌、子宫复旧等症状的临床疗效和安全性,为促进剖宫产术后康复增加多一种有效、经济、安全的方法,并希望在临床得以推广,促进剖宫产术后恢复以及婴幼儿的健康成长。【方法】本文在前期临床研究的基础上,选取广州市越秀区妇幼保健院产科住院部产妇100例(纳入标准和排除标准),经过简单随机化的分组方法,将手术日期为奇数者为观察组(50例),偶数者则为对照组(50例)。在同等术后常规处理条件下,分别予以口服加减运脾饮和温开水,观察并对比各组产妇术后腹胀情况、肛门排气及排便时间、初乳出现时间以及乳汁分泌量、恶露持续时间、体温、舌象以及肝功、肾功等临床观察指标,经过相关的统计分析(SPSS13.0软件包),以证实加减运脾饮在促进剖宫产术后康复的有效性和安全性。【结果】(1)100例产妇中观察组平均年龄为29.24±3.78(岁),对照组平均年龄为30.51±3.12(岁),经t检验,P>0.05,提示无显著性差异,具有可比性。(2)观察组和对照组于产后1天经症状自评量表打分,分别是13.43±1.58,13.26±1.37,经t检验,P>0.05,两组自评症状得分无明显差异,具有可比性。(3)两组产妇中,服用加减运脾饮的观察组在胃肠功能恢复时间、自主功能恢复时间、初乳出现时间以及恶露持续时间方面都比对照组要短。(4)治疗剖宫产术后主要症状的临床疗效,观察组显效13例,有效22例,好转11例,无效4例,总有效率92%；对照组显效3例,有效12例,好转20例,无效15例,总有效率70%。观察组初乳出现的平均时间为24.04±6.46(小时),对照组初乳出现的平均时间为31.53±7.61(小时)。观察组恶露持续的平均时间为19.57±5.8(天),对照组恶露持续的平均时间为17.72±6.25(天)。分别用卡方检验和t检验,P<0.05,提示加减运脾饮能促进剖宫产术后胃肠功能恢复、初乳的出现以及子宫的复旧。(5)术后第1天,观察组的谷丙转氨酶(ALT)和谷草转氨酶(AST)分别是27.12±7.8549(IU/L),21.34±6.3023(IU/L)；尿素氮(UA)和肌苷(CR)分别是5.3680±1.1786(mmol/L),68.5800±15.8344(umol/L).术后第4天,观察组的ALT和AST分别是26.54±7.3491(IU/L),19.71±6.5458(IU/L)；UA和CR分别是5.0520±1.1003(mmol/L),69.8100±15.2466(umol/L).经t检验,P>0.05,提示观察组在服药前后肝肾功能无显著性差异,其余血常规、尿常规和心电图在用药前后未见异常,说明加减运脾饮临床用药安全可靠。【结论】(1)临床观察提示,加减运脾饮在促进剖宫产术后康复方面有较好的临床疗效,与对照组相比有显著性统计学意义。(2)本研究初步提示加减运脾饮具有有效、经济、安全的优点,值得进一步扩大样本含量进行多中心、大样本的临床研究,为推广中医药在促进剖宫产术后康复的临床应用方面提供依据。更多还原

【Abstract】 Based on the preliminary studies of Yunpiyin in the treatment of gynecological surgery postoperative complications, it is to observe the clinical efficacy and drug safety of the modification of Yunpiyin in promoting restoration of the gastrointestinal function、milk-secretion、involution uterus etc. It adds an extra efficient、economical and safe way to promote the recovery of cesarean section. It is hoped to be popularized in clinical to promote recovery of the patient from cesarean section and infant’s healthy growth.MethodsIn this study, on the early clinical research basis, it selects 100 cases from Maternity and child Health Hospital obstetrical in-patient department of Yuexiu district in Guangzhou(inclusion criteria and exclusion criteria).Through a simple randomized grouping method, the surgery date that are odd date are assigned as observation group(50 cases), those are even are assigned as control group(50 cases). Under the same postoperative conventional treatment condition, groups are respectively given oral modification of Yunpiyin and warm water, they are observed and compared by the index of abdominal distension anus flatus and defecation time、colostrum appear time and breast milk secretory volume、lochia duration、temperature、tongue picture and liver function, renal function and other indicators of clinical observation. After relevant statistical analysis(SPSS13.0 software), it is to confirm the effectiveness and safety of modification of Yunpiyin in promoting cesarean section postoperative restoration.Results(1) In the 100 cases, the average age of observation group is 29.24±3.78 (years old), that of control group is 30.51±3.12(years old). By the t test (P>0.05), there are no significant differences between the two groups, it is comparable.(2) One day after delivery, symptom self-rating scores of observation group and control group are respectively 13.43±1.58,13.26±1.37. By t test, trere are no significant differences of the symptom Self-rating score between two groups(P>0.05),it is comparable.(3) Between the two groups, the treatment group that takes the medicine takes shorter time in respect of recovery of gastrointestinal function, independent function recovery time, the appearance time of colostrum and the duration of lochia than those of the control group.(4)Among the observation group, there are 13 cases markedly effective,22 cases effective,11 cases experienced improvement,4 cases null and void. The total efficient rate of the clinical efficacy of the treatment is 92%. Among the control group,3 cases markedly effective,12 cases effective,20 cases experienced improvement,15 cases of ineffective, the total effective rate is 70%. The average appearance time of colostrum in the observation group is 24.04±6.46 (h), that in the control group is 31.53±7.61 (h). The average duration of lochia in the observation group is 13.57±5.8(d), the average duration of lochia in the control group is 17.72±6.25 (d). By chi-square test and the t-test respectively (P<0.05), it suggests that the modification of YunPiYin can Promote the recovery of gastrointestinal function after cesarean section, the emergence of colostrum and redintegration of the uterus.(5) One day after the operation, the ALT and AST of the observation group are respectively 27.12±7.8549(IU/L),21.34±6.3023(IU/L);The UA and CR are respectively 5.3680±1.1786(mmol/L),68.5800±15.8344(umol/L). Four days after the operation, the ALT and AST of the observation group are respectively 26.54±7.3461(IU/L),19.71±6.5458(IU/L);The UA and CR are respectively 5.0520±1.1003(mmol/L),69.8100±15.2466(umol/L). By t-test, P>0.05, it prompts the observation group that the liver and kidney function is of no significant difference before and after the surgery, the rest of routine urine、blood test and electrocardiogram didn’t have any abnormal symptons before and after meditation, demonstrating that the clinical medication of Yunpiying is secure.Conclusion(1) Clinical observation suggests that modification of Yunpiyin has a better efficiency in promoting cesarean section postoperative restoration of patients. Compared with the control group, it is of great statistical significance.(2) This study preliminarily promotes that the modification of Yunpiyin is effective, economical and safe, it is worth to further expand the sample size, multi-center, large sample of clinical research. It provides a basis for popularizing Chinese medicine in promoting restoration of cesarean section postoperative complications in clinical application. v更多还原