安胎Ⅰ号穴位贴敷改善肾虚型先兆流产患者症状的临床研究

发布时间：2018-04-10 23:16

本文选题：穴位贴敷法 + 先兆流产　；参考：《浙江中医药大学》2016年硕士论文

【摘要】：目的：观察安胎Ⅰ号穴位贴敷改善肾虚型先兆流产患者症状的临床效果,分析改善症状的相关因素,为肾虚型先兆流产患者选择安全有效地改善症状的中医护理方法提供科学依据。方法于2015年5月-12月,便利选取在杭州市中医院诊疗的肾虚型先兆流产患者78例,随机分为干预组和对照组,各39例。对照组接受由同一中医师制定的中西医结合治疗方案及常规健康教育；干预组在对照组基础上接受安胎Ⅰ号穴位贴敷,每日1次,每次6-8小时,7次为1疗程,共2个疗程。评估并记录两组入组前、入组7天、入组14天的中医证候积分(主/次症)、人绒毛膜促性腺激素(HCG)、孕酮(P)、雌二醇(E2)、焦虑自评量表(SAS)；受试对象每天采用观察法和视觉模拟量表(VAS)对阴道出血、腰酸及腹痛进行自我评估,计算穴位贴敷后阴道出血、腰酸、腹痛缓解时间；跟踪随访至妊娠12周,根据胎儿颈项透明层(NT)比较两组继续妊娠率。结果：完成全部资料收集的受试对象73例,其中对照组36例,干预组37例,两组继续妊娠率比较,无统计学差异(P0.05)。1.入组前、入组7天、入组14天,三次重复测量的结果显示,两组次症中医证候积分组间差异无统计学意义(P0.05),但与时间存在交互作用(P0.05);两组主症中医证候积分组间差异具有统计学意义(P0.05),随入组时间的延续呈下降趋势(P0.05),且干预组下降程度大于对照组。2.两组阴道出血持续率比较,无统计学差异(P0.05),对照组、干预组中位持续时间分别为4天、6天；两组腰酸、腹痛持续率比较,均有统计学差异伊0.05),对照组、干预组腰酸中位持续时间分别为12天、3天,腹痛中位持续时间分别为11天、6天。3.Cox比例风险回归模型显示,穴位贴敷、宫腔镜、入组前腰酸持续时间、孕周为缩短肾虚型先兆流产患者腰酸、腹痛症状持续时间的重要独立影响因素。其中穴位贴敷(RR=6.44,95%Cl:3.07～13.59)、宫腔镜(RR=0.39,95%CI:0.39～0.82)、入组前腰酸持续时间(RR=0.92,95%CI:0.85～0.99)是影响腰酸改善的因素(P0.05);穴位贴敷(RR=3.44,95%CI:1.84～6.45)、孕周(RR=0.61,95%CI:0.41～0.92)是影响腹痛改善的因素(P0.05)。4.入组14天,两组孕酮水平均较入组前升高,有统计学差异伊0.05);组间比较无统计学差异(P0.05)。5.入组14天,两组SAS评分均较入组前降低,有统计学差异(P0.05);组间比较无统计学差异(P0.05)。结论1.安胎Ⅰ号穴位贴敷可改善肾虚型先兆流产患者主症中医证候,是腰酸、腹痛改善的保护因素；2.临床上应加强对有宫腔镜史者、入组前腰酸持续时间长者、孕周大于6周者进行腰酸、腹痛改善缓慢的健康宣教；3.在贴敷期间,安胎Ⅰ号穴位贴敷对HCG、 E2、P、SAS评分无影响,改善症状安全可靠,值得临床推广应用。
[Abstract]:Objective: to observe the clinical effect of Acupoint Application No. 1 of Anfen on improving the symptoms of threatened abortion patients with kidney deficiency type, and to analyze the related factors of improving symptoms.To provide scientific basis for the choice of TCM nursing method to improve symptoms safely and effectively in patients with threatened abortion of kidney deficiency type.Methods from May to December, 2015, 78 patients with renal deficiency threatened abortion who were diagnosed and treated in Hangzhou traditional Chinese Medicine Hospital were randomly divided into intervention group and control group, each with 39 cases.The control group received the treatment plan and routine health education made by the same traditional Chinese medicine doctor, and the intervention group received the ANFI acupoint application on the basis of the control group, once a day, 6-8 hours and 7 times each time as a course of treatment, a total of two courses of treatment.The two groups were evaluated and recorded 7 days before they entered the group.The TCM syndromes scores (main / secondary symptoms, HCG, progesterone, estradiol estradiol E2P, self rating anxiety scale (SAS)) of 14 days in the study group were used to treat vagina hemorrhage, and the subjects were treated by observing method and visual analog scale (VASS) every day.Lumbar acid and abdominal pain were self-evaluated to calculate the time of vaginal bleeding, lumber acid and abdominal pain relief after acupoint application, followed up to 12 weeks of pregnancy, and compared the rate of continuous pregnancy between the two groups according to the transparent layer of fetal neck (NTS).Results: there were 73 subjects with complete data collection, including 36 cases in control group and 37 cases in intervention group. There was no significant difference in the rate of continuous pregnancy between the two groups (P 0.05).Before joining the group, 7 days, 14 days into the group, the results of three repeated measurements showed that,There was no significant difference in TCM syndromes integral between the two groups (P 0.05), but there was interaction with time (P 0.05), and the difference between the two groups had statistical significance (P 0.05), which showed a decreasing trend with the duration of entering the group (P 0.05) and dry.The degree of decrease in pretreated group was greater than that in control group.There was no significant difference in the duration of vaginal bleeding between the two groups (P 0.05), while the median duration in the control group was 4 days or 6 days, while the rates of lumbar acid and abdominal pain in the two groups were significantly higher than those in the control group.The median duration of lumbar acid in the intervention group was 12 days / 3 days, and the median duration of abdominal pain was 11 days and 6 days respectively. 3. Cox proportional risk regression model showed that acupoint application, hysteroscopy and anterior lumbar acid duration were observed in the intervention group.Gestational week is an important independent factor for shortening lumbar acid and duration of abdominal pain symptoms in patients with threatened abortion of kidney deficiency type.The level of progesterone in the two groups was higher than that before the entry, and there was no statistical difference between the two groups (P 0.05. 5).On the 14th day, the SAS scores of the two groups were significantly lower than those of the control group (P 0.05), but there was no significant difference between the two groups (P 0.05).Conclusion 1.Antii No. 1 acupoint application can improve the main symptoms of kidney deficiency type threatened abortion patients TCM syndrome, is the lumbar acid, abdominal pain improvement of the protective factors 2.The patients with hysteroscopic history, the patients who had a history of hysteroscopy, the patients who had a history of hysteroscopy, the patients who had a history of hysteroscopy, the patients who had a lasting time of anterior lumbar acid, and those who were pregnant more than 6 weeks should be given lumbar acid.During the application period, the application of Acupoint Antii No. 1 had no effect on the scores of HCG, E2P and SAS, and it was safe and reliable to improve the symptoms, which was worthy of clinical popularization and application.
【学位授予单位】：浙江中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R248.3

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