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1、 屈螺酮炔雌醇片联合加味生化颗粒在人工流产术后的应用效果 伍丽燕李小梅刘霞摘要目的 探討屈螺酮炔雌醇片联合加味生化颗粒在人工流产术后的应用效果。方法 选取2016年8月2017年8月肇庆医学高等专科学校附属医院妇科门诊收治的人工流产患者进行考察,患者均为非意愿妊娠、自愿终止妊娠,既往无生育或人工流产史,平素月经均正常,孕龄610周。行人绒毛膜促性腺激素(-HCG)及B超确定宫内妊娠后,筛选出162例人工流产患者作为研究对象,将其随机分为治疗组和对照组,每组各81例。治疗组患者采用屈螺酮炔雌醇片联合加味生化颗粒进行治疗,对照组患者采用维生素E胶囊治疗。比较两组患者术后3周的阴道出血持续时间、子宫
2、内膜厚度及术后6周的月经复潮时间。结果 排除中止研究患者后,本研究治疗组有效纳入病例为71例,对照组为74例。术后3周回院复诊,治疗组患者的阴道出血持续时间短于对照组,子宫内膜厚度高于对照组,差异有统计学意义(P0.05)。术后6周电话回访,治疗组患者的月经复潮时间短于对照组,差异有统计学意义(P关键词人工流产术;屈螺酮炔雌醇片;加味生化颗粒 R169.42 A 1674-4721(2018)7(b)-0134-03Abstract Objective To explore the application effect of Drospirenone and Ethinylestradiol
3、Tablets combined with Flavored Biochemical Granules after induced abortion. Methods From August 2016 to August 2017, women who underwent induced abortion at the gynecologic outpatient of the affiliated hospital of zhaoqing medical college were selected as the research subjects. All the selected subj
4、ects were unintended pregnant, voluntarily terminated, and had no history of childbirth or abortion, whose menstruation was normal, with 6 to 10 gestational weeks.Diagnosed with intrauterine pregnancy by Human Chorionic Gonadotropin (-HCG) and B ultrasound, a total of 162 pregnant women were selecte
5、d and randomly divided into treatment group and control group with 81 cases in each group. The treatment group was treated with Drospirenone and Ethinylestradiol tablets combined with flavored biochemical granules and the control group was treated with vitamin E capsules. The oluration of vaginal bc
6、eeding and endometrial thickness at 3 weeks and menstrual rehydration time at 6 weeks after surgery in both groups were compared. Results After eliminating the discontinuation of study patients, 71 cases were effectively included in the treatment group and 74 cases in the control group. Return visit
7、 after 3 weeks, the duration of vaginal bleeding in the treatment group was shorter than that of the control group, the endometrial thickness was higher than that of the control group, and the differences were statistically significant (P0.05). After a 6-week telephone interview, the time of menstru
8、al recovery was shorter than that of the control group, and the difference was statistically significant (P0.05),具有可比性。本研究经我院医学伦理委员会审核批准,所有患者均知晓本研究情况并签署知情同意书。1.2方法两组患者于我院妇科门诊手术室行人工流产手术,均于术后当天始予口服头孢他啶片。头孢他啶为三代头孢菌素,常用于术后常规抗感染治疗,用法:1 g/次,3次/d,连服5 d。同时,治疗组患者于术后当天口服屈螺酮炔雌醇片及加味生化颗粒,屈螺酮炔雌醇片用法:1片/次,1次/d,连服21
9、 d;加味生化颗粒用法:15 g/次,3次/d,连服10 d。对照组患者于术后当天口服维生素E胶囊,用法:1粒/次,3次/d,连服21 d。嘱患者术后3周回院复诊,术后6周电话随访。1.3病例中止标准有以下情况者,中止该病例研究:于治疗期间出现因药物或其他因素所导致产生严重不良反应者;治疗期间因胚胎组织残留或宫腔积血需行二次清宫者;无法按时、按量服用药物的,依从性差者;未能按时回院复诊者,或因各种原因自行退出研究者4。1.4观察指标患者术后3周回院复诊,主要了解以下内容:行阴道B超观察子宫内膜厚度;了解阴道持续出血时间,即人工流产术后当天始阴道不间断出血到出血停止所用时间。术后6周电话回访,主
10、要询问患者人工流产术后月经复潮时间7。1.5统计学方法采用SPSS 24.0统计学软件进行数据分析,计量资料用均数标准差(xs)表示,两组间比较采用t检验;计数资料用率表示,组间比较采用2检验,以P0.05为差异有统计学意义。2结果2.1两组患者纳入病例情况162例人工流产者中,共发生5例不良反应,治疗组4例,对照组1例;3例未按要求服药,治疗组1例,对照组2例;9例失访,治疗组5例,对照组4例。以上患者均中止研究,因此本研究治疗组有效纳入病例为71例,对照组为74例。2.2两组患者术后3、6周复诊疗效指标的比较术后3周,治疗组患者的阴道出血持续时间短于对照组,子宫内膜厚度高于对照组,差异有统
11、计学意义(P0.05);术后6周,治疗组患者的月经复潮时间短于对照组,差异有统计学意义(P0.05)(表1)。3讨论人工流产术为有创操作,可导致宫内感染、宫腔黏连、子宫穿孔,甚至造成继发性不孕等并发症,严重危害妇女的生殖健康。人工流产术后阴道异常出血常由下列原因造成:绒毛与蜕膜残留、子宫内膜修复延迟甚至障碍、子宫内膜炎9。有研究指出10-11,绒毛组织一旦完全排出,蜕膜组织便呈碎片状随阴道血在短时间内排出,阴道出血时间一般较短。若有绒毛组织残留,即便少许也会引起持续性出血。目前认为,绒毛和蜕膜残留主要是由于子宫收缩不良引起的。子宫内膜修复延迟甚至障碍者,临床常表现为月经过少、月经延期、闭经等。
12、内分泌检查一般显示其水平无异常,盆腔彩超检查则多显示子宫内膜血流信号不丰富12。分析认为,人工流产术可能对子宫内膜相关血管造成损伤,损伤血管使其出现硬化甚至再生障碍,子宫内膜血液灌注不足,导致子宫内膜修复异常。有研究报告指出13,对人工流产后宫腔刮出物和分泌物进行病理检查,发现所有受检患者送检物均呈现炎症细胞浸润,且送检物浸润程度与患者出血时间成正相关。认为炎症可能由出血时间长所造成的,但炎症的出现同样影响子宫内膜修复。屈螺酮炔雌醇片每片含3 mg屈螺酮和30 g炔雌醇,是一种短效复方口服的避孕药。其所含的少量烯炔雌为雌激素的一种,能使子宫平滑肌对催产素的敏感度提高,使宫缩加强,从而减少人工流产后阴道出血时间14。它既可对受损的子宫内膜起到及时修复的作用,还可减少宫内小动脉栓塞,进而减少宫腔黏连。屈螺酮炔雌醇片中所含的高效孕激素可致子宫内膜分泌期出现变化,可令已萎缩甚至粘连的蜕膜组织完全性剥离脱落,促进其排出宫腔。高效孕激素还能对局部纤溶亢进起抑制作用,可维持子宫内膜血管稳定,既修复又止血。宫颈细胞的分泌作用也可被高效孕激素抑制,使黏