【作者】 李硕熙；

【导师】 黄敏；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2012， 硕士

【摘要】 研究背景近年来国内育龄妇女中人工流产数逐渐增加,尤其是未生育年轻妇女要求人工流产的数目与日俱增。尽管人流技术在不断改进,但随着人工流产率的不断增加,导致了术后各种并发症的发生率也在增高,特别是早孕人流不全、人流术后出血时间长、感染、月经不调等严重影响了育龄妇女的生殖健康,若不加以重视,长此以往又可导致包括慢性盆腔炎、子宫内膜异位症、继发性不孕、月经紊乱等严重的远期并发症,影响广大妇女的生活及家庭。术后并发症中,近期发生率为1.98%,远期为4.39%,其中继发不孕率为1.38%,子宫内膜异位症为0.14%。近期并发症又以术后阴道流血为突出表现,故本研究具有一定的现实、社会意义。目前西医对人流后阴道流血症状改善有限,本课题即通过观察艾灸疗法配合加味生化汤在减少人流术后阴道流血量、缩短阴道流血时间、促进子宫复旧、减缓腹痛、改善中医证候等方面的临床疗效,并进行分析,以期探求出一种疗效确切、安全方便、价格低廉的治疗方案。研究目的为降低人流术后并发症提供安全有效的治疗方案,并通过本研究为开展人流术后早期干预降低人工流产对育龄妇女的不良影响,对预防人流术后近期并发症进行积极探索,以提高育龄妇女生殖健康水平。研究方法本研究采用随机、对照试验,将符合纳入标准的中医体质辨识为气虚质的孕10周内育龄妇女分为对照组(常规应用抗生素预防感染)、中药组(对照组基础上加服中药)与试验组(对照组基础上采用艾灸疗法配合中药治疗组),每组40例,观察阴道流血量、阴道持续流血时间、腹痛等临床症状,建立数据库，进行统计分析,以期判定药灸并用改善人流术后并发症的疗效及安全性。结果1.对照组、中药组及灸药组的总有效率分别为86.84%、89.74%及97.30%,三组比较,差异有显著差异(p<0.01)。组间进行比较时,灸药组、中药组的疗效好于对照组(p<0.05)。中药组疗效与灸药组比较差异无统计学意义(p>0.05)。2.三组患者的中医证候疗效总有效率分别为81.58%、94.87%及97.3%,差异有统计学意义(p<0.05)。灸药组、中药组有效率明显高于对照组,且灸药组优于中药组,说明艾灸疗法对改善中医症候方面有改善作用。3.对照组、中药组、灸药组治疗后月经复潮时间无统计学意义。说明艾灸疗法、中药治疗对患者月经恢复无影响。结论艾灸疗法配合中药治疗能够缩短人流后阴道流血时间,疗效确切；与单纯服用中药相比,艾灸疗法配合中药治疗对减少人流术后阴道流血量有明显的促进作用；中医症候疗效和临床症状、体征改善方面,对照组、中药组及灸药组的中医证侯疗效总有效率分别为81.5%,9.4.87%及97.3%,差异有统计学意义,且灸药组在改善中医症候方面要优于单纯采用中药疗法。更多还原

【Abstract】 BackgroudIn recent years, the number of artificial abortion in women of childbearing age increased gradually, especially in nulliparous young women require abortion number grow with each passing day. Although the artificial abortion technique is in continuous improvement, with the abortion rate increased continuously, an abortion complication rate also increased, especially in early pregnancy abortion, incomplete abortion bleeding after a long time, infection and irregular menstruation has seriously affected the reproductive health of women of childbearing age.If do not try to take seriously, it can lead to some serious long term complications, such as chronic pelvic inflammatory disease, including endometriosis, secondary infertility, menstrual disorders and others. The recent postoperative complication was1.98%, while the forward was4.39%. In which the secondary infertility rate was1.38%, endometriosis was0.14%. Vaginal bleeding plays an important role in Postoperat ive complications, thus, this study has certain practical, social significance. At present the improvement of symptoms by western medicine on vaginal bleeding after artificial abortion are relatively limited. This paper through the observation of clinical curative effect by moxibustion therapy, which is treated as a complementary therapy of Jiawei Shenghua tisane in reducing amount of vaginal bleeding, shorten the time of vaginal bleeding, abdominal pain, promoting uterine involution, easing the syndrome of traditional Chinese medicine. Through the analysis, to explore a set of exact curative effect, safety and convenience, low cost treatment options.ObjectiveTo provide a safe and effective method for the prevention and treatment of vaginal bleeding after artificial abortion by using moxibustion as a complementary therapy of Jiawei Shenghua tisane to Vaginal bleeding after Artificial Abortion.MethodA random and compare sampling method was used in this study, and a total of120cases with vaginal bleeding after artificial abortion were recruited into the study, which have been divided into3groups of control group, traditional Chinese medicine group and moxibustion with traditional Chinese medicine group. Subjects in control group were medicated with Cephradine capsule3days after artificial abortion,0.25g,p.o, bid. Subjects in traditional Chinese medicine group were treated with Jiawei Shenghua tisane100ml, bid,1week after artificial abortion,and the treatment mentioned above.Subjects in moxibustion with traditional Chinese medicine group were treated with moxibustion7days after artificial abortion, there are6accupoints (RN4, RN6), EX-CA1(dual), SP1(dual), SP6(dual), ST36(dual)were selected for treating, qd,1week for a course, and both two treatments as mentioned above. Subjects’signs and symptoms were recorded before and after treatment.Result1.The total efficiency of control group, traditional Chinese medicine group and moxibustion with traditional Chinese medicine group are86.84%,89.74%and97.30%. By Fisher’s Exact Test, the difference has statistical signi fi cance (p<0.01). The efficiency of moxibustion with traditional Chinese medicine group and traditional Chinese medicine group are higher than that of control group (p<0.05). The difference of efficiency between moxibustion with traditional Chinese medicine group and traditional Chinese medicine group is not signi ficant (p>0.05).2. The total effect ive rates wi th TCM Syndromes of three groups are81.58%,94.87%and97.3%, the difference has statistical significance (p<0.05). Moxibustion with traditional Chinese medicine group is Significantly higher than that of control group and traditional Chinese medicine group.3. The return of menses times of control group, the Chinese medicine group and moxibustion with traditional Chinese medicine group after treatment is not statistically significant. Description of moxibustion therapy, Chinese medicine treatment of menstruation in patients with no effect (p>0.05).Conclusion To compare the effect of Moxibustion with traditional Chinese medicine in the treatment for vaginal bleeding after induced abortion, Moxibustion presents outstanding results in improving TCM symptoms, alleviating clinical symptoms and signs. Thus,to combine both the two treatments (moxibustion and the traditional Chinese medicine) in clinical use can definitely improve Clinical efficacy and TCM symptoms and help the patients obtain a better life quality.更多还原