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缩宫止血合剂治疗药物流产后出血(气虚血瘀证)的临床观察
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摘要
米非司酮配伍米索前列醇终止早孕的方法,以其安全有效、使用方便、痛苦小已在临床广泛使用10余年,并日益被广大育龄妇女所接受,在计划生育中所起的作用不容忽视。但还有其不足之处,诸如药物流产后出血时间长,流血量多,甚至潜在大出血的危险,这不仅有损健康、给患者带来痛苦,而且可诱发盆腔炎、不孕症,因此如何减少药物流产后出血量、缩短出血时间等问题亟待解决。对此,广大医务工作者作了大量的努力,并已取得了一定的成果,但尚不是十分令人满意。如何发挥中医药的优势,弥补药物流产的不足,以进一步提高药物流产的使用,已成为一项紧迫的任务。
    药物流产后出血属中医“产后恶露不绝”范畴。根据产后多虚多瘀的特点,同时鉴于现代医学认为药物流产后出血量多和(或)时间长的原因,主要是子宫收缩乏力、绒毛或蜕膜组织残留、米非司酮对纤溶系统的影响、易合并宫内感染等病因病理特点,我们采用辨病与辨证相结合的方法,以“补虚不留瘀,祛瘀不伤正”为治疗原则,采用益气祛瘀、缩宫止血之缩宫止血合剂治疗本病的气虚血瘀证,取得了较好效果。其方主要由党参、三七粉、益母草、紫草等组成,其组成紧紧扣住虚、瘀这一病机。方中党参补气,药理证实其有兴奋子宫的作用;三七粉活血化瘀,止血,药理证明其对动物血管有收缩作用,缩短其凝血时间,有止血作用;益母草苦泄辛散,主入血分,善于活血祛瘀调经,为妇科经产要药。药理研究表明其对多种动物的离体、在体、未孕、已孕或产后子宫均具明显兴奋作用,使子宫收缩频率、幅度及紧张度增加;紫草清热凉血、活血化瘀、解毒。药理研究证实紫草具有以下作用:对实验动物能降低毛细血管通透性,促进创伤愈合,对金黄色葡萄球菌、大肠杆菌、流感病毒等病原微生物有抑制作用。缩宫止血合剂正是通过这些补气、祛瘀、止血、抗炎、收缩子宫的中药,达到益气祛瘀、缩宫止血的目的。本课题对缩宫止血合剂治疗药物流产后出血的作用进行了临床观察,证实了缩宫止血合剂的疗效,初步探讨了其作用机理。
    临床观察:将65名本院自愿要求药物流产的病人随机分为试验组35例和对照组30例。两组均于第一、二天早上9点服米非司酮50mg,晚上9点服米非司酮25mg,服药前后均空腹2小时,第3天早上来院空腹顿服米索前列醇600μg,留院观察6小时,胎囊排出后,当天开始,试验组予服缩宫止血合剂,每次100ml,每日2次,连用7天;对照组予口服益母草冲剂,15g/次,2次/天,连用7天。结果表明:试验组完全流产率为91.43%,对照组为86.67%,两组比较无统计学差异,P>0.05;阴道流血持续天数前者为10.69±5.16天,后者为13.73±5.47天,两组比较有统计学差异,P<0.05,流血时间≤2周者前者占75%,后者占57.69%,两者差异显著,P<0.05,试验组出血时间较对照组明显缩短;气虚血瘀中医证候的改善方面,试验组总有效率为91.43%,对照组为76.67%,两者差异显著,P<0.05;阴道流血量少于月经量者,试验组占53.125%,对照组占26.92%,两者差异显著,P<0.05,试验组流血量少于对照组;两者转经时间及转经经期无统计学差异,说明本方对月经恢复无影响。
    以上临床观察表明,缩宫止血合剂能改善药物流产后气虚血瘀症状,缩短药物流产后出血时间,减少出血量,对月经复潮无不良影响,而且未见明显毒副作用,是一安全有效的方药,对临床药物流产的进一步开展具有促进作用,应当加以更深入的研究。另外,为方便患者携带和服用,可考虑将本方改良为
    
    散剂或丸剂,以易于为患者所接受。本试验样本量偏少,是本文不足之处,有待今后扩大样本量进一步观察。
The means of Ru486 combined with Misoprostol to terminate early pregnancy has been employed abroad over 10 years in clinic because of its safety and efficiency and convenience in use and slight pain, and is accepted increasingly by immense women in bearing age. Its action in family planning is not allowed to be ignored. But there are shortages, such as long duration and large amount of bleeding, even there is danger of latency massive haemorrhage. This not only damages health、brings pain to suffer, and it may place a premium on Pelvic Inflammatory、Sterility Disease. So that how to reduce bleeding quantity and shorten bleeding duration after medical abortion is urgent to be resolved. Withal, numerous medical operators make great efforts, and have acquired definite harvest. But it still doesn't quite turn up trumps. That how to exert the dominance of herbalist doctor and medicine and make up deficiency of medical abortion in order to bring up employment of medical abortion has been a pressing task.
    Haemorrhage after medical abortion belongs to category of persistent lochia after delivery in Chinese Medicine. Gynecology theory of Herbalist doctor takes for that there is much deficiency and stasis after delivery. Modern physic take for that the main cause of large amount of bleeding and(or)long duration after medical abortion.is tiredness of uterus shrinking、remnant of villus and decidua tissue、mifepristone's influence on fibrinolysis system、easily uniting infection, and so on. Whereas characteristic hereinbefore, we adopt means of combination of disease differentiation and syndrome differentiation And according to the curing principle of reinforcing the deficiency but no remaining stasis and removing stasis but no injuring genuine qi, we take SuoGong ZhiXue which can replenish qi and remove stasis、shrink uterus and stop bleeding to cure qi deficiency and blood stasis syndrome of this disease. And good effect has been acquired. The prescription is mainly composed of Radix Codonopsis pilosulae、Powder of Radix Notoginseng、Herba Leonuri、Radix Arnebiae seu Lithospermi etc, and its constitution fastens firmly the pathological mechanism of deficiency and stasis. In this prescription, Radix Codonopsis pilosulae supplement middle-jiao energy, pharmacological proves that it can stimulate uterus. Powder of Radix Notoginseng can promote blood circulation to remove blood stasis and stop bleeding. Pharmacological proves that it exerts a vasoconstrictive effect on the vessles of animal's leg, and shortens clotting time and exerts hemostatic effect. Herba Leonuri is acrid and bitter in taste, and is attributive to the blood phase, and is good at activating blood flow、removing blood stasis、regulating menstruation. It is the important medicine of catamenia and after delivery in gynecology. Pharmacological research proves that it can evidently stimulate manifold animals' uterus which has left body or is in body and isn't pregnant or is already pregnant or is after delivery and increase uterus' shrinking frequency、range、tensity; Radix Arnebiae seu Lithospermi can clear away heat and cool the blood、promote blood circulation to remove blood stasis、remove toxic material. Pharmacological research proves that it bears hereinafter actions:It can decrease the permeability of capillaries and promote wound healing in experimental animal; and restrain pathogeny microorganism such as Gold Staphylococcus、E.Coli、Flu Virus. SuoGong ZhiXue HeJi just have these Chinese traditional medicine which can invigorate qi、remove stasis、stop bleeding、resist inflammation and shrink uterus to invigorate qi and remove stasis、shrink uterus and stop bleeding. This problem carries through a clinic
    
    observation to SuoGong ZhiXue HiJi's action of curing bleeding after medical abortion and approves its curative effect and makes a primary discussion to its acting mechanism.
    Clinic observation:65 patients who are unconstraint to ask medical abortion are allocated randomly into 2 groups: treated group which contains 35 patients and antithet
引文
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