杜宝俊教授治疗卵巢储备功能下降的经验总结

发布时间：2019-02-24 17:41

【摘要】：背景：卵巢储备功能下降(Diminished Ovarian Reserve,DOR)是育龄期妇女较为常见的生殖内分泌疾病,在不孕症人群中,发病率约为10%。近年来由于生活节奏不断的加快,空气质量及生活环境的持续恶化,生活及工作的压力的不断增加,其发病率有逐年上升的趋势。但是由于卵巢储备功能下降起病隐匿,临床表现多无特异性,患者常因为不孕就诊时发现患有此病。若不及时有效的干预,可发展为卵巢早衰。虽然不是危及人类生命的急病、重病,但是能够引起女性生育能力的下降及围绝经期的一系列症状,给患者造成极大的生理和心理负担,甚至会影响家庭的稳定,值得我们持续深入的关注和研究。由于目前卵巢储备功能下降的发病机制尚不明确,现代医学对其尚无特异性的有效治疗手段,多为对症治疗：对无生育要求的病人采用激素替代疗法以改善症状,减少并发症的发生；对有生育要求的病人多采用辅助生殖技术治疗,但其妊娠率由于受卵子、胚胎质量以及子宫内膜容受等因素的影响而比较低,约30%-40%。中医从整体出发,辨证施治,采用多角度、多靶点、全方位的整体调治,并注重个体化诊疗,临床取得了满意的疗效。许多研究表明,中医药治疗卵巢储备功能下降疗效优势明显,已成为卵巢储备功能下降的重要治疗手段。目的：杜宝俊教授从医近三十年,致力于中医药治疗不孕不育症及妇科生殖内分泌疾病的临床研究,在卵巢储备功能下降的中医治疗上逐渐形成了自己独具特色的诊疗思路,本文旨在通过整理和总结其对卵巢储备功能下降的临床治疗经验,从而为中医治疗卵巢储备功能下降提供新的思路和方法。方法：通过检索现代医学及中医学文献对卵巢储备功能下降病因、病机、治则、治法的相关论述,总结了现代医学对卵巢储备功能下降的认识和评估方法及卵巢储备功能下降的诊疗现状以及存在的问题；同时较系统回顾了古代文献及现代中医对本病症的认识及诊疗经验,总结了中医药对本病的病因、病机、治法的认识,以期更好地总结和领会导师治疗本病的经验。通过近三年跟随导师临诊、授课,以及总结病历和回顾相关文献等方式,总结了导师对卵巢储备功能下降病因病机的认识及辨证论治特点、治法及用药特点。结果：杜宝俊教授在治疗卵巢储备下降过程中,逐渐形成了一套较完整且独具特色的辨证思路和诊疗方法,导师认为该病病位在肾,病机主要是肾虚,可兼见肝郁、脾虚、血虚、血瘀,治法以补肾为主,注重肾肝脾同调,养血活血并用。导师在中药辨证施治的同时联合针刺疗法,并重视心理疏导,临床取得了满意的疗效,较西医治疗有明显优势,其经验值得总结、推广。结论：杜宝俊教授对于卵巢储备功能下降的认识和治疗具有独到的见解,临床疗效显著。其经验具有较强的临床指导价值,并可为认识和诊治卵巢储备功能下降提供新的思路。
[Abstract]:BACKGROUND: The decline of ovarian reserve function (DOR) is a more common reproductive and endocrine disease of women in the age of childbearing age. In the infertility population, the incidence rate is about 10%. In recent years, due to the increasing pace of life, the continuous deterioration of air quality and living environment, and the increasing pressure of life and work, the incidence of life has increased year by year. However, due to the low function of ovarian reserve, the disease is hidden, the clinical manifestations are not specific, and the patient is often found to have the disease due to the infertility. If there is no timely and effective intervention, it can be developed into premature ovarian failure. Although not life-threatening, serious illness, but it can cause the decline of female fertility and a series of symptoms of perimenopausal period, which can cause a great physical and psychological burden to the patient, and even affect the stability of the family, which is worth our continued in-depth attention and research. Because the pathogenesis of the decline of the function of the ovarian reserve is not clear, the modern medicine has no specific effective means of treatment, which is for the symptomatic treatment: the hormone replacement therapy is adopted for patients with no reproductive requirements to improve the symptoms and reduce the occurrence of the complications; The rate of pregnancy is low, about 30% to 40%, due to the influence of the ovum, the quality of the embryo and the tolerance of the endometrium. The traditional Chinese medicine is based on the whole, the differentiation and treatment, the multi-angle, multi-target, all-round overall adjustment, and the individual diagnosis and treatment, the clinical results have achieved the satisfactory curative effect. Many studies have shown that the effect of traditional Chinese medicine in the treatment of the function of ovarian reserve is obvious, and has become an important therapeutic means for the decline of the function of the ovarian reserve. Objective: Professor Du Bao-jun has been devoted to the clinical study of the treatment of infertility due to infertility and the reproductive endocrinopathy in the past three decades, and has gradually formed its own unique diagnosis and treatment idea on the treatment of the decline of the function of ovarian reserve. The aim of this paper is to provide a new thought and method for the reduction of the function of the ovarian reserve by arranging and summarizing its clinical experience in the decline of the function of the ovarian reserve. Methods: The diagnosis and evaluation of the function of ovarian reserve function and the diagnosis and treatment of the decline of the function of the ovarian reserve and the existing problems were summarized by searching the related discussion of the etiology, the machine, the treatment and the treatment of the function of ovarian reserve in modern medicine and the literature of traditional Chinese medicine. At the same time, the understanding of the ancient literature and the modern Chinese medicine on the condition and the experience of the diagnosis and treatment of the disease were reviewed, and the cause, the disease and the treatment of the disease were summarized, with a view to better summarizing and understanding the experience of the tutor in the treatment of the disease. Through the follow-up of the tutor in the last three years, the teaching, the summary of the medical records and the review of the relevant literature, the paper summarized the understanding of the cause of the decline of the function of the ovarian reserve by the tutors and the characteristics of the treatment and treatment and the characteristics of the treatment. Results: In the course of the decline of the ovarian reserve, Professor Du Bao-jun gradually formed a complete and unique thought and method of diagnosis and treatment, and the teacher thought that the disease was in the kidney and the disease machine was mainly due to the deficiency of the kidney. It can also be used as the main part of the kidney, spleen deficiency, blood deficiency, blood stasis, and the treatment of the kidney. It is focused on the liver and spleen of the kidney, and is used for nourishing blood and promoting blood circulation. At the same time, the tutor combined with the acupuncture therapy in the treatment of the syndrome differentiation of the traditional Chinese medicine, and attached great importance to the psychological guidance. The clinical results achieved satisfactory curative effect, and the treatment with western medicine has obvious advantages, and the experience is worth summarizing and promoting. Conclusion: Professor Du Bao-jun has a unique insight into the cognition and treatment of the function of ovarian reserve, and the clinical effect is significant. The experience has a strong clinical guidance value and can provide a new way for understanding and diagnosing the decline of the function of the ovarian reserve.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R249;R271.9

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