益气凉血安宫方剂对促进产后...改善子宫动脉血流方面的价值_刘青.pdf

13 赵明宇,鲍铁周,赵启,等.基于平乐正骨“筋滞骨错”理论推拿治疗膝关节骨性关节炎疗效评价 J.中华中医药杂志,2017,32(3):1372-1374.14Jing Feng,Guo Xinfeng.Victoria towers,Litopenia K,LitopeniaK,Litopenia K,et al.The effect of traditional Chinese medicinebony setting combined with Xiaotong powder in the treatment of van-namedic disc herniation and its influence on patients quality of lifeJ.Journal of Clinical Research&Practice,2019,4(17):125-127.15 毕锴,温建民,董颖.阴阳,筋骨理论在中西医结合微创技术治疗拇外翻中的应用 J.中医杂志,2015,56(14):1202.16 Chen Dexiong,Gao Xing.Clinical study of self-designed ZhuyuZhitong prescription combined with manual bone setting in the treat-ment of lumbar disc herniation J.Shi Zhen Traditional ChineseMedicine and Traditional Chinese Medicine,2017,28(9):2177-2179.17 黄加张,马昕,王旭,等.拇外翻术后再手术的原因分析及处理对策 J.中华骨科杂志,2013,33(4):393-397.(收稿日期 2021-03-15)通讯作者:闵莉,大学本科,主治医师,研究方向:妇产科疾病;作者简介:刘青,本科,研究方向:手术室 方面,E-mail:15926226161 。益气凉血安宫方剂对促进产后子宫恢复、改善子宫动脉血流方面的价值刘青1,闵莉2,(1.武汉市中医医院,湖北 武汉 430000;2.黄石市妇幼保健院(湖北理工学院附属医院),湖北 黄石 435000)摘要:目的:探讨益气凉血安宫方剂对促进产后子宫恢复、改善子宫动脉血流方面的价值。方法:将 87 例产后子宫复旧不全患者采用简单随机法分为两组,对照组 43 例给予缩宫素+抗生素治疗,观察组 44 例在对照组用药基础上给予益气凉血安宫方剂治疗。比较两组恶露情况、腰腹疼痛消失时间、中医证候积分和疗效,检测两组治疗前后 B超下子宫三径和子宫动脉血流差异。结果:观察组恶露持续时间、腰腹疼痛消失时间短于对照组,平均恶露量少于对照组(P0.05)。治疗后与本组治疗前比较,两组恶露不绝、血色紫黯、血质黏稠、小腹疼痛、面色潮红、心胸烦躁、口燥咽干积分及总积分均下降。治疗后与对照组比较,观察组中医证候积分明显更低(P0.05)。治疗后与本组治疗前比较,两组子宫动脉收缩期峰值流速(PSV)升高,B 超下子宫三径及子宫动脉阻力指数(RI)、搏动指数(PI)均下降。治疗后与对照组比较,观察组子宫动脉 PSV 明显更高,子宫三径及子宫动脉 RI、PI 明显更低(P0.05)。观察组总有效 41 例,总有效率为 93.18%,高于对照组的 33 例和 76.74%,有统计学意义(P0.05)。结论:益气凉血安宫方剂可缩短产后子宫复旧不全患者恶露持续时间,促进子宫恢复、改善子宫动脉血流,提高疗效。关键词:益气凉血安宫方剂;子宫复旧不全;恶露;子宫动脉血流;疗效 中图分类号:R 271.43 文献标志码:A 文章编号:1000-3649(2023)02-0166-04 Clinical Value of Yiqi Liangxue Angong Recipe for Promoting Postpartum Uterine Recovery and Improving UterineArtery Blood Flow/LIU Qing1,MIN Li2,/1.Wuhan Municipal Traditional Chinese Medicine Hospital(Wuhan Hubei 430000,China);2.Huangshi Maternal and Child Health Hospital the Affiliated Hospital of Hubei Institute of Technology(Huangshi Hu-bei 435000,China)Abstract:Objective:To explore the value of Yiqi Liangxue Angong Recipe for promoting postpartum uterine recovery andimproving uterine artery blood flow.Methods:A total of 87 patients with postpartum uterine involution were divided into twogroups by the simple random method,43 cases in the controlled group were treated with Oxytocin and Antibiotics,and 44 cases inthe observation group were treated with Yiqi Liangxue Angong Recipe on the basis of the controlled group.The lochia,waist andabdominal pain disappearance time,TCM syndrome score and curative effect were compared between the two groups,and thedifferences in the three uterine diameters and uterine artery blood flow under B-ultrasound before and after treatment between thetwo groups were detected.Results:The duration of lochia and the disappearance of waist and abdominal pain in the observationgroup were shorter than those in the controlled group,and the average amount of lochia was less than that in the controlled group(P0.05).After treatment,compared with before treatment in this group,the scores of persistent lochia,dark purple blood,thick blood,ab-661四 川 中 医Journal of Sichuan of Traditional Chinese Medicine2023 年第 41 卷第 2 期Vol.41,No.2,2023dominal pain,flushing,irritability,dry mouth and throat,and total scores in the two groups decreased.After treatment,com-pared with the controlled group,the TCM syndrome scores of the observation group were significantly lower(P0.05).After treatment,compared with before treatment in this group,the peak systolic velocity(PSV)of uterine arteries in the two groups increased,and the three uterine diameters,uterine arterial resistance index(RI)and pulsa-tility index(PI)under B-ultrasound all decreased.After treatment,compared with the controlled group,the PSV of the uterineartery in the observation group was significantly higher,and the three diameters of the uterus and the RI and PI of the uterine ar-tery were significantly lower(P0.05).The total effective rate was 93.18%in the observation group of 41 cases,which washigher than that in the controlled group of 33 cases and 76.74%,with statistical significance(P0.05)。纳入标准:(1)符合 实用妇产科学4标准;(2)年龄18 岁,35 岁;(3)辨证符合 中医病证诊断疗效标准5中血热型标准:子宫收缩乏力,恶露不绝,血色紫黯有血块,血质黏稠;小腹疼痛拒按,面色潮红,心胸烦躁,口燥咽干;舌紫黯或有瘀点,脉虚数;(4)患者已经同意。排除标准:(1)伴有生殖系统肿瘤;(2)伴有心脑血管、肝肾或造血、呼吸系统疾病;(3)其他原因引起的阴道异常流血;(4)患者精神异常;(5)过敏体质。1.2方法对照组给予缩宫素+抗生素治疗,肌内注射宫缩素注射液(上海第一生化药业有限公司,规格:1mL:10U,国药准字 H31020862)10U/次,2 次/d。口服抗生素头孢拉定胶囊(中美上海施贵宝制药有限公司,规格:0.25g,国药准字 H31020001)0.5g/次,3 次/d。观察组在对照组用药基础上给予益气凉血安宫方剂治疗。益气凉血安宫方:黄芪30g、太子参 10g、生地黄 15g、丹皮 15g、赤芍 15g、益母草 15g、当归 10g、川芎 10g、三七粉 3g(冲服)、茜草炭 10g、地榆炭 10g,金银花 15g、败酱草15g、阿胶 6g(烊化)、炙甘草 6g。上药每日 1 剂,水煎取汁 300ml,分两次早晚温服,每次 150ml。两组均连续治疗 7d 后评价疗效。1.3观察指标和检测方法比较两组恶露情况(恶露持续时间和平均恶露量)、腰腹疼痛消失时间、中医证候积分和疗效,检测两组治疗前后 B 超下子宫三径和子宫动脉血流差异。中医证候积分:参考中医病证诊断疗效标准5制定:主证包括恶露不绝、血色紫黯、血质黏稠,次证包括小腹疼痛、面色潮红、心胸烦躁、口燥咽干。采用 Likert 4 级评分法评估主证和次证的严重程度,分别赋予 0 6 分和03 分,分值高表示症状重。子宫三径和子宫动脉血流:于治疗前、治疗 7d 后采用腹部超声检测子宫三径(长径、前后径、横径之和)、子宫动脉收缩期峰值流速(PSV)、子宫动脉阻力指数(RI)、搏动指数(PI)。检测仪器:飞利浦 EPIQ7 彩色多普勒超声诊断仪。疗效:痊愈为 3d 内恶露停止,中医证候积分降低90%,且阴道 5d