發(fā)布時(shí)間：2018-01-22 12:26

  本文關(guān)鍵詞： 益腎促排卵湯 排卵障礙性不孕 刺激周期　出處：《南京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本研究采用益腎促排卵湯聯(lián)合人絨毛膜促性腺激素(HCG)對(duì)排卵障礙性不孕患者刺激周期進(jìn)行干預(yù),觀察該法的臨床療效,探討其可能的作用機(jī)制,為中西醫(yī)結(jié)合治療排卵障礙性不孕提供臨床參考,為治療排卵障礙性不孕癥提供新的思路和方法。方法:95例排卵障礙性不孕患者,符合納入標(biāo)準(zhǔn),按隨機(jī)、對(duì)照的原則分為治療組(益腎促排卵湯+HCG組,32例)、對(duì)照組1(單純HCG組,31例)、對(duì)照組2(血府逐瘀口服液+HCG組,32例),三組均于經(jīng)周第5天起口服來(lái)曲唑(LE,2.5mg/d)5天,同時(shí)于周期第5天起服用滋陰奠基湯,B超監(jiān)測(cè)卵泡發(fā)育,酌情輔以尿促性素(HMG)促進(jìn)優(yōu)勢(shì)卵泡發(fā)育成熟,當(dāng)卵泡直徑≥16mm時(shí),給予相應(yīng)干預(yù)措施;B超確認(rèn)排卵后口服健黃助孕湯,若月經(jīng)來(lái)潮或妊娠停用。比較三組卵泡質(zhì)量及優(yōu)勢(shì)卵泡排出情況、未破裂卵泡黃素化綜合征(LUFS)發(fā)生率、臨床妊娠率、流產(chǎn)率、卵巢動(dòng)脈血流、子宮內(nèi)膜厚度、中醫(yī)臨床癥候評(píng)分,并探討益腎促排卵湯對(duì)排卵障礙的簡(jiǎn)要作用機(jī)制。結(jié)果:①治療組排卵率76.25%,LUFS發(fā)生率13.75%;對(duì)照組1排卵率49.41%,LUFS發(fā)生率29.41%;對(duì)照組2排卵率65.0%,LUFS發(fā)生率20.0%。治療組與對(duì)照組1在排卵率、LUFS發(fā)生率上差異有統(tǒng)計(jì)學(xué)意義(P0.05),治療組與對(duì)照組2、對(duì)照組1與對(duì)照組2在排卵率、LUFS發(fā)生率上差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。②治療組妊娠14例,流產(chǎn)1例,妊娠率46.7%;對(duì)照組1妊娠6例,流產(chǎn)1例,妊娠率20%;對(duì)照組2妊娠7例,流產(chǎn)1例,妊娠率24.1%,三組妊娠率差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),可能與樣本量過(guò)少有關(guān)。三組在流產(chǎn)率上差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。③治療組與對(duì)照組1、對(duì)照組2在治療后的單卵泡發(fā)育率分別為63.75%、56.47%、56.25%(P0.05);治療組與對(duì)照組1、對(duì)照組2卵泡質(zhì)量在治療后差異有統(tǒng)計(jì)學(xué)意義(P0.05),對(duì)照組1與對(duì)照組2在治療后差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。④治療組與對(duì)照組1、對(duì)照組2卵巢基質(zhì)動(dòng)脈血流的PI、RI、S/D值在治療前差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),治療后差異有統(tǒng)計(jì)學(xué)意義(P0.05)。⑤治療組與對(duì)照組1、對(duì)照組2排卵日的子宮內(nèi)膜厚度分別為9.19±0.68mm、8.57±0.50mm、8.49±0.55mm,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。經(jīng)兩兩對(duì)照,治療組與對(duì)照組1、對(duì)照組2的差異有統(tǒng)計(jì)學(xué)意義(P0.05)。⑥在綜合療效方面,治療組18例痊愈,7例顯效,3例有效,2例無(wú)效,總有效率93.3%;對(duì)照組110例痊愈,7例顯效,6例有效,7例無(wú)效,總有效率76.7%;對(duì)照組2 15例痊愈,7例顯效,3例有效,4例無(wú)效,總有效率86.2%。治療組總有效率高于對(duì)照組1和對(duì)照組2,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),考慮與樣本量小有關(guān)。⑦三組病例治療前、治療后中醫(yī)癥候積分的比較無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),治療前后的中醫(yī)癥候積分對(duì)比有統(tǒng)計(jì)學(xué)意義(P0.05)。治療組與對(duì)照組的中醫(yī)臨床癥狀均獲得明顯改善,有效率達(dá)80%以上。結(jié)論:在"補(bǔ)腎活血,化瘀通絡(luò)"的原則下,抓住"的候期"這一氣血氤氳時(shí)期,運(yùn)用益腎促排卵湯聯(lián)合HCG對(duì)排卵障礙性不孕刺激周期進(jìn)行干預(yù),可明顯提高排卵率,降低LUFS發(fā)生率,并提高卵泡的質(zhì)量,改善卵巢動(dòng)脈血流,促進(jìn)優(yōu)質(zhì)卵泡發(fā)育成熟及排出,促進(jìn)子宮內(nèi)膜的增長(zhǎng),從而獲得滿意的妊娠率。補(bǔ)腎活血中藥亦可通過(guò)調(diào)節(jié)機(jī)體陰陽(yáng)狀態(tài)平衡,使氣血通暢,臟腑協(xié)調(diào),從而改善中醫(yī)臨床癥狀。
[Abstract]:Objective: To study the tonifying kidney and promoting ovulation decoction combined with human chorionic gonadotropin (HCG) intervention on anovulatory infertility patients stimulation cycle, observe the clinical curative effect, to explore its possible mechanism, provide reference for clinical treatment of anovulatory infertility for traditional Chinese medicine and Western medicine, to provide new ideas and methods for the treatment of anovulatory infertility. Methods: 95 cases of anovulatory infertility patients, met the inclusion criteria, were randomly divided into treatment and control group (Yishen Decoction for ovulation induction in group +HCG, 32 cases) and control group (1 HCG group, 31 cases), control group 2 (blood stasis oral liquid group +HCG, 32 cases), three groups were in the week fifth day oral letrozole (LE, 2.5mg/d) for 5 days, at the same time in the period of fifth days taking Ziyin based decoction, ultrasound monitoring of follicular development, as appropriate, with Menotropins (HMG) to promote the dominant follicle maturation when follicle the diameter is not less than 16mm, to Give the corresponding intervention measures; ultrasound confirmed after ovulation, oral health yellow Zhuyun decoction, if menstruation or pregnancy disabled. The quality of the follicle and advantages of the three groups ovulation, luteinized unruptured follicle syndrome (LUFS) incidence rate, clinical pregnancy rate, abortion rate, ovarian artery blood flow, endometrial thickness, clinical score TCM syndrome, and to explore the tonifying kidney and promoting ovulation decoction on ovulation disorders brief mechanism. Results: the treatment group ovulation rate was 76.25%, the incidence rate of LUFS was 13.75%; the control group of 1 ovulation rate was 49.41%, the incidence rate of LUFS was 29.41%; the control group of 2 ovulation rate was 65%, the incidence rate of LUFS in 20.0%. treatment group and control group 1 in ovulation rate LUFS, there was a significant difference (P0.05), the treatment group and the control group 2, control group 1 and control group 2 in the ovulation rate, LUFS incidence rate had no significant difference (P0.05). The treatment group of 14 cases of pregnancy, abortion in 1 cases, the pregnancy rate was 46.7%; the control group of 1 pregnant women 6渚，

本文編號(hào)：1454660