柴胡桂枝汤联合短期激素补充治疗围绝经期综合征的临床观察.pdf

103临床研究 2023 年 09 月第 31 卷第 09 期作者简介：刘红玲，女，副主任医师,本科。研究方向：妇科临床方向。中西医结合治疗柴胡桂枝汤联合短期激素补充治疗围绝经期综合征的临床观察刘红玲(郑州市金水区总医院 妇科，河南 郑州 450003)摘要：目的 探讨柴胡桂枝汤联合短期激素补充治疗围绝经期综合征的临床效果。方法 选取 2019 年 1 月至 2020年 8 月在郑州市金水区总医院妇科门诊接受治疗的 80 例围绝经期综合征患者，按照随机数字表达法分为研究组(40 例，柴胡桂枝汤联合短期激素补充治疗)与对照组(40 例，短期激素补充治疗)，观察治疗前、后患者内分泌水平、症状及子宫内膜厚度变化情况，比较两组患者的治疗效果与不良反应发生率。结果 治疗前两组卵泡雌激素(FSH)、雌二醇(E2)水平比较，差异无统计学意义(P 0.05)；治疗后，研究组 FSH 水平显著低于对照组，E2水平显著高于对照组，差异有统计学意义(P 0.05)。治疗前两组症状评分、子宫内膜厚度比较，差异无统计学意义(P 0.05)；治疗后，研究组症状得分低于对照组，子宫内膜厚度明显高于对照组，差异有统计学意义(P 0.05)。研究组治疗有效率显著高于对照组，差异有统计学意义(P 0.05)；两组不良反应发生率比较，差异无统计学意义(P 0.05)。治疗前两组焦虑抑郁量表评分比较，差异无统计学意义(P 0.05)；治疗后，研究组焦虑、抑郁评分低于对照组，差异有统计学意义(P 0.05)。治疗前两组匹兹堡睡眠质量指数(PSQI)评分比较，差异无统计学意义(P 0.05)；治疗后研究组患者 PSQI 低于对照组，差异有统计学意义(P 0.05)。结论 柴胡桂枝汤联合短期激素补充治疗围绝经期综合征能够调节激素分泌，改善临床症状，效果确切且安全。关键词：柴胡桂枝汤；短期激素补充；围绝经期综合征中图分类号：R271.9文献标志码：B DOI：10.12385/j.issn.2096-1278(2023)09-0103-04Clinical Observation on the Combination of Chaihu Guizhi Decoction and short-term Hormone Supplementation in the Treatment of perimenopausal SyndromeLIU Hongling(Department of Gynecology,Jinshui District General Hospital,Zhengzhou Henan 450003,China)Abstract:Objective To explore the clinical effect of Chaihu Guizhi decoction combined with short-term hormone supplementation in the treatment of perimenopausal syndrome.Method A total of 80 patients with perimenopausal syndrome who received treatment at the gynecology clinic of Jinshui District General Hospital in Zhengzhou City from January 2019 to August 2020 were randomLy divided into a study group(40 cases,Chaihu Guizhi decoction combined with short-term hormone supplementation treatment)and a control group(40 cases,short-term hormone supplementation treatment)according to the expression of random numbers.Endocrine levels,symptoms,and changes in endometrial thickness of the patients were observed before and after treatment,the treatment efficacy and incidence of adverse reactions between two groups of patients were compared.Results Before treatment,there was no statistically significant difference in the levels of follicle estrogen(FSH)and estradiol(E2)between the two groups(P 0.05);After treatment,the FSH level in the study group was significantly lower than that in the control group,and the E2 level was significantly higher than that in the control group,with a statistically significant difference(P 0.05).There was no statistically significant difference in symptom scores and endometrial thickness between the two groups before treatment(P 0.05);After treatment,the symptom score of the study group was lower than that of the control group,and the endometrial thickness was significantly higher than that of the control group,with a statistically significant difference(P 0.05).The effective rate of treatment in the study group was significantly higher than that in the control group,with a statistically significant difference(P 0.05);There was no statistically significant difference in the incidence of adverse reactions between the two groups(P 0.05).There was no statistically significant difference in the scores of the anxiety and depression scales between the two groups before treatment(P 0.05);After treatment,the anxiety and depression scores of the study group were lower than those of the control group,and the difference was statistically significant(P 0.05).There was no statistically significant difference in the Pittsburgh Sleep Quality Index(PSQI)scores between the two groups before treatment(P 0.05);After treatment,the PSQI of the study group patients was lower than that of the control group,with a statistically significant difference(P 0.05).Conclusion Chaihu Guizhi decoction combined with short-term hormone supplementation can regulate hormone secretion,improve clinical symptoms,and have a definite and safe effect in the treatment of perimenopausal syndrome.Key Words:Chaihu Guizhi decoction;short term hormone supplementation;perimenopausal syndrome更年期综合征的临床症状之一便是围绝经期综合征，由于雌性激素波动而导致的妇女在绝经前会出现月经紊乱、潮热、情绪波动、易怒等身体和心理症状1。若该症状没有得到及时有效的干预，可对患者的身心健康造104Clinical Research,Sept.2023,Vol.31 No.09成影响，比如导致患者抑郁、焦虑，以及导致患者出现心血管系统、泌尿生殖系统等疾病2。在医学史上对围绝经期综合征并无明确记载，归属于中医学“百合病”“年老血崩”“脏躁”等范畴，西医临床认为3本病与围绝经期激素波动引起的自主神经系统功能紊乱有直接关系，因此在治疗时主张通过激素治疗进行调节，然而长期激素治疗存在较大的局限性，因此探讨更为安全有效的治疗方案尤为重要。柴胡桂枝汤出自伤寒论，近年来有学者4发现其在围绝经期综合征治疗中效果确切，鉴于此，郑州市金水区总医院妇科门诊在近年来收治的部分围绝经期综合征患者的治疗中采用柴胡桂枝汤辅助短期激素补充治疗，效果确切，具体报告如下。1资料与方法1.1临床资料选取自 2019 年 1 月至 2020 年 8 月在本院接受治疗的 80 例围绝经期综合征患者作为研究对象，按照随机数字表达法分为研究组、对照组，各为 40 例。研究组年龄 45 55 岁，平均(52.311.06)岁；病程 3 个月 4 年，平均(1.630.29)年。对照组年龄 45 55岁，平 均(52.391.10)岁；病 程 3 个 月 4 年，平均(1.600.30)年。两组患者临床资料比较，差异无统计学意义(P 0.05)，具有可比性。本研究经本院伦理委员会审核并批准。1.2纳入与排除标准纳入标准：符合围绝经期综合征在妇产科学5中的诊断依据，符合中医病证诊疗常规6中对该综合征的标准依据，即主要症状为头痛、眩晕，次症为烘热、月经紊乱、急躁易怒、心悸、胁腹胀痛、失眠、食少；年龄 45 55 岁；除月经失调外，伴有潮热出汗这一特异症状，伴有或不伴有失眠、激动易怒等其他症状；内分泌检查卵泡雌激素(FSH)、雌二醇(E2)异常；超声检查无器质性病变；无激素治疗禁忌；知晓本次研究并自愿参与。排除标准：使用激素类药物治疗每个月未超过三次的患者；精神异常、认知功能异常或伴有自身免疫系统疾病者。1.2方法对照组，采用短期激素补充治疗。每次取雌激素0.3mg，每天每晚睡前一次，合计 25d；每月后半周期每晚加用一次安宫黄体酮 4mg，连续用药 12d。研究组采用柴胡桂枝汤联合短期激素补充治疗，如下：(1)柴胡桂枝汤，柴胡、桂枝、黄芪、清半夏、白芍、党参、当归、红花、郁金、