中药孕吐方治疗妊娠恶阻30例临床观察及机理探讨

【作者】 程丽丽；

【导师】 徐谦；

【作者基本信息】 湖北中医学院 ， 中医妇科， 2006， 硕士

【摘要】 目的：观察中药孕吐方结合补液治疗妊娠恶阻的临床疗效，并深入探讨该方的作用机理，为临床治疗提供依据。 方法：选取2004年6月到2005年10月在武汉市一医院门诊及病房就诊的早期妊娠者90例，其中诊断为妊娠恶阻，辨证属气阴两虚型的患者60例，正常妊娠者30例。60例妊娠恶阻患者按入院顺序随机分为治疗组（n=30）和对照组（n=30），正常妊娠者设为正常组（n=30）与治疗组及对照组进行比较。对照组采用常规补液疗法：静脉输入10％葡萄糖注射液，生理盐水1500-2000ml，林格液1000ml，加入维生素C2g，维生素B₆0.1g，ATP40mg，肌苷针0.4g，依电解质结果加入碳酸氢钠射液125ml或（和）10％KCL10ml，随患者病情的改变酌情加减补液量。治疗组在静脉补液的基础上口服自拟补气养阴、和胃安胎的中药孕吐方（太子参15g、麦冬20g、白术10g、黄芩10g、石斛20g、木香6g、苏梗10g、桑寄生15g、菟丝子15g、竹茹10g、乌梅10g、甘草5g），浓煎取汁200ml频服当茶饮。两组均于治疗前及开始治疗第7天空腹抽取肘静脉血8ml，其中4ml立刻送医院检验科检测电解质浓度及肝肾功能，余4ml离心取血清置-20℃冰箱中保存，用放免法检测胃动素（MOT）：采用北京市福瑞生物工程公司生产的胃动素放免药盒；用酶联免疫法检测血清人绒毛膜促性腺激素（β-HCG）：采用北京市福瑞生物工程公司生产的β-HCG定量酶联免疫分析（ELISA）试剂盒。 结果：1．治疗开始后第7天，治疗组及对照组的治愈率分别为76.7％、56.7％，有显著性差异（P＜0.05）；总有效率分别为96.7％，90％，无显著性差异（P＞0.05）；患者治愈出院停药2周后，治疗组及对照组的复发率分别为16.7％、33.3％，有显著性差异（P＜0.05）。 2．治疗前治疗组、对照组、正常组的血清β-HCG分别为：136230±15120mIu／ml、155816±14624 mlU／ml、129213±10528 mIU／ml。治疗组血清β-HCG明显低于对照组，两组之间有显著差异（P＜0.05）；治疗组与正常组之间无显著差异（P＞0.05）；对照组明显高于正常组，两组之间有显著差异（P＜0.05）。 3．治疗前治疗组、对照组、正常组，的血清胃动素值分别为67.15±15.94、70.28±13.56、145.35±30.12。治疗组与对照组之间无显著差异（P＞0.05），两组与正常组之间有显著差异（p＜0.05）；治疗后治疗组与对照组分别为151.50±54.84，103.28±38.31，两组之间有显著差异（P＜0.05），治疗组与正常组之间无显著差异（P＞0.05），对照组与正常组之间有显著差异（p＜0.05）。 结论：1．治疗组与对照组的总有效率无显著差异，但治疗组的治愈率显著高于对照组，恶心呕吐等症状好转或消失、酮体转阴、电解质肝肾功能恢复正常，疗效明显好于对照组。提示中药孕吐方结合补液治疗妊娠恶阻，疗效优于单纯西医补液治疗。 2．两组患者在治疗后血清胃动素含量均显著提高，提示妊娠恶阻的发生与孕妇血清胃动素降低有相关性；治疗组患者的血清胃动素值明显高于对照组，此可能是孕吐方有效治疗妊娠恶阻的机理之一。 3．血清β-HCG的值与妊娠恶阻的发生有关，但与呕吐的程度不成正比。更多还原

【Abstract】 Objective:To study the clinical therapeutic effect of YunTuFang combining intravenous fluid infusion therapy on the patients suffering Vomiting During Pregnancy（VDP） and explore the mechanism .Methods :90 early-pregnant women in Department of gynecology of Hospital No.1 Wuhan during May 2004 to Oct. 2005 were collected,60 cases of VDP in which were devided into two groups randomly as therapy group（n=30） and control group（n=30）. The normal early-pregnant were compared with the forenamed groups as the normal group.Therapy group was treated with the YunTuFang of invigorating qi,nourishing yin,harmonizing stomach and calming fetus in the base of intravenous fluid infusion treatment,while the control one was given only the general treatment. YunTuFang Prescription （YP,mainlycomposed of Pesudostellariae heterophy lla,Scute llaria baicalensis Georgi,Aucklandia lappa Decne, Atractylodes macro Cephala Koidz, Ophiopogon japonicus ,Dendrobium , Stems of Perrila frutescens Britt, Suscuta chinen sis Lam,Taxillus chinensis,Prunus mume, Bamboo bark, Glycyrrhiza）. The decoction was to be taken in small doses at short interval .The general treatment was privided as following :5%GS ,NS,1000₁500ml and Ringer’s 2000 ml,added vitamin C 2g, vita min B₆ 0.1g ,ATP（Adenosine Triphosphate）40mg, inosine injection 0.4,and sodium bicarbonate injection 125ml,and （or）the 10% injection KCL 10ml acording to the results of serum electrolytes. The concentration of MOT was detected with ELISA and which of P-HCG was mearured with electrochemiluminescence （ECL） when the treatment had been begun for 6 days.Results :1. The recovery rate and the total effective rate were76.7% and 96.7% in therapy group and 56.7% and 90% in control group. By verification,the difference of the recovery rate between the two groups was distinct statistical significance （p < 0.05）,but the difference of the total effective rate wasn’t obvious.2.The concentrations of P-HCG in the therapy, control and normal group were 136230 ± 15120 mlU/ml , 155816 ± 14624 mlU/ml , 129213 ± 10528 mlU/ml respectively before treatment. The serum P-HCG levels in treatment group were lower than the control one, the diference between them was significant（P < 0.05）,and which of the control one was obviously higher than the normal one ,the diference was significant（P < 0.05）.While the difference between the treatment and the control group was not significant （P > 0.05）.3.The concentrations of MOT in therapy group and control one were 67.15± 15.94 and 70.28±13.56 respectively before treatment,which were not significantly diferrent and obviously lower than the level of the normal one （145.35 ± 30.12 ）. The MOT levels of the VDP had increased significantly compared with those before the treatment,but which of treatment group（151.50±54.84） were significantly higher than the control one（103.28±38.31）. The difference of the MOT level between the treatment and the nomal group was not significant （P > 0.05）, while the difference between the control and normal group was obvious（P < 0.05）.Conclusion :1. The concentration of P-HCG showed significant in relation to VDP.2. MOT showed significant correlation with VDP which maybe the mechanism更多还原